From the Guidelines
Hyperkalemia is primarily caused by kidney dysfunction, medication effects, and excessive potassium intake, as well as other factors such as adrenal insufficiency, tissue breakdown, acidosis, and hereditary disorders, as noted in the most recent study 1. The causes of hyperkalemia can be categorized into several key areas, including:
- Kidney dysfunction, which impairs potassium excretion, particularly in patients with chronic kidney disease (CKD) 1
- Medication effects, particularly from ACE inhibitors, ARBs, potassium-sparing diuretics, NSAIDs, and certain antibiotics like trimethoprim 1
- Excessive potassium intake from supplements or salt substitutes
- Adrenal insufficiency, which reduces aldosterone production
- Tissue breakdown conditions like rhabdomyolysis or tumor lysis syndrome, which release intracellular potassium
- Acidosis, which drives potassium out of cells
- Insulin deficiency
- Certain hereditary disorders like Gordon syndrome
- Pseudohyperkalemia, a laboratory artifact from hemolysis during blood collection, can also produce falsely elevated readings 1 Patients with diabetes, heart failure, or advanced age face higher risks of developing hyperkalemia, as noted in 1. It is essential to identify and address the underlying cause of hyperkalemia for effective management, which may include treatments such as calcium gluconate, insulin with glucose, beta-agonists, sodium bicarbonate, diuretics, potassium binders, or dialysis in severe cases.
From the Research
Causes of Hyperkalemia
The causes of hyperkalemia can be attributed to various factors, including:
- The use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) 2, 3, 4, 5, 6
- Chronic renal insufficiency, as these patients are more prone to developing hyperkalemia due to decreased potassium excretion 2, 3, 4, 5, 6
- Excessive potassium intake from diet, supplements, or drugs that can increase serum potassium 2, 6
- Congestive heart failure, which can increase the risk of hyperkalemia in patients using ACEi or ARB 3
- The use of loop or thiazide diuretic agents, which can reduce the risk of hyperkalemia in patients using ACEi or ARB 3
- Advanced age, with patients over 70 years being at a higher risk of developing severe hyperkalemia 3
- Reduced glomerular filtration rate (GFR), as the incidence of hyperkalemia increases with declining GFR 5
Risk Factors for Hyperkalemia
Several risk factors can increase the likelihood of developing hyperkalemia, including:
- Diabetes mellitus, although it does not affect the incidence of hyperkalemia independent of GFR 5
- Baseline serum potassium concentration, with higher concentrations increasing the risk of hyperkalemia 5
- Concurrent use of medications that can increase serum potassium, such as potassium-sparing diuretics or supplements 2, 6
- Renal function, with patients having chronic kidney disease being at a higher risk of developing hyperkalemia 4, 5, 6