Jay Ian Lakkis1, Matthew R Weir2. 1. University of Hawaii John A. Burns School of Medicine, 95 Maui Lani Pkwy, Wailuku, HI, 96793-2416, USA. 2. Division of Nephrology, University of Maryland School of Medicine, 22 S. Greene St., Room N3W143, Baltimore, MD, 21201, USA. mweir@medicine.umaryland.edu.
Abstract
PURPOSE OF REVIEW: Hyperkalemia develops in a patient with systemic arterial hypertension (HTN) if one or more risk factors are present, namely chronic kidney disease (CKD) (especially severe stage 4-5 CKD), diabetes mellitus (DM), heart failure (HF), or pharmacological therapies that interfere with potassium homeostasis, mainly through renin-angiotensin-aldosterone inhibition (RAASi). Hyperkalemia is a considerable reason of morbidity (emergency department (ED) visits and hospitalizations) and portends a higher mortality risk in patients at risk; for instance, hyperkalemia increases the risk of mortality within 1 day of a hyperkalemic event. This review aims to identify the risk factors for high-serum potassium, highlight the risk versus benefit of RAASi in certain patient populations, and outline preventive as well as therapeutic strategies for hyperkalemia. RECENT FINDINGS: A growing body of evidence supports the safety and efficacy of cation-exchange resins, patiromer, or sodium zirconium cyclosilicate, in patients with a compelling indication for RAASi, yet in whom such therapy was complicated by hyperkalemia, allowing these patients to benefit from continued RAASi therapy. In summary, novel cation exchange polymers present the clinician with a new and safe strategy to address hyperkalemia in patients with a compelling indication for ongoing RAASi therapy instead of withdrawal of such therapy.
PURPOSE OF REVIEW: Hyperkalemia develops in a patient with systemic arterial hypertension (HTN) if one or more risk factors are present, namely chronic kidney disease (CKD) (especially severe stage 4-5 CKD), diabetes mellitus (DM), heart failure (HF), or pharmacological therapies that interfere with potassium homeostasis, mainly through renin-angiotensin-aldosterone inhibition (RAASi). Hyperkalemia is a considerable reason of morbidity (emergency department (ED) visits and hospitalizations) and portends a higher mortality risk in patients at risk; for instance, hyperkalemia increases the risk of mortality within 1 day of a hyperkalemic event. This review aims to identify the risk factors for high-serum potassium, highlight the risk versus benefit of RAASi in certain patient populations, and outline preventive as well as therapeutic strategies for hyperkalemia. RECENT FINDINGS: A growing body of evidence supports the safety and efficacy of cation-exchange resins, patiromer, or sodium zirconium cyclosilicate, in patients with a compelling indication for RAASi, yet in whom such therapy was complicated by hyperkalemia, allowing these patients to benefit from continued RAASi therapy. In summary, novel cation exchange polymers present the clinician with a new and safe strategy to address hyperkalemia in patients with a compelling indication for ongoing RAASi therapy instead of withdrawal of such therapy.
Authors: Faiez Zannad; John J V McMurray; Henry Krum; Dirk J van Veldhuisen; Karl Swedberg; Harry Shi; John Vincent; Stuart J Pocock; Bertram Pitt Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: Hans L Hillege; Dorothea Nitsch; Marc A Pfeffer; Karl Swedberg; John J V McMurray; Salim Yusuf; Christopher B Granger; Eric L Michelson; Jan Ostergren; Jan Hein Cornel; Dick de Zeeuw; Stuart Pocock; Dirk J van Veldhuisen Journal: Circulation Date: 2006-02-07 Impact factor: 29.690