From the Guidelines
Hyperkalemia is primarily caused by kidney dysfunction, medication effects, and excessive potassium intake, and its management should prioritize individualized monitoring and treatment to prevent life-threatening cardiac arrhythmias. The most common causes of hyperkalemia include:
- Kidney dysfunction, which impairs potassium excretion 1
- Medication effects, particularly from ACE inhibitors, ARBs, potassium-sparing diuretics, NSAIDs, trimethoprim, and certain immunosuppressants like tacrolimus 1
- Excessive potassium intake from supplements or salt substitutes 1 Other significant causes include:
- Adrenal insufficiency, which reduces aldosterone production 1
- Acidosis, which drives potassium out of cells 1
- Tissue breakdown conditions like rhabdomyolysis or tumor lysis syndrome 1
- Severe hyperglycemia 1
- Pseudohyperkalemia, which can occur from hemolysis during blood collection, extreme thrombocytosis, or leukocytosis 1
- Certain genetic disorders like Gordon syndrome or type 4 renal tubular acidosis 1 According to the most recent study 1, individualized monitoring of serum potassium and the use of newer potassium-binding agents may allow for optimization of renin-angiotensin-aldosterone system inhibitor therapy and more effective management of hyperkalemia. Key considerations in managing hyperkalemia include:
- Reviewing the patient's medication list to identify potential causes of hyperkalemia 1
- Assessing kidney function to determine the severity of kidney dysfunction 1
- Examining for signs of tissue breakdown and considering endocrine disorders that might affect potassium regulation 1
- Using oral potassium-binding agents to manage hyperkalemia, particularly in patients with chronic kidney disease or heart failure 1
From the Research
Causes of Hyperkalemia
- Hyperkalemia is a potentially life-threatening complication that can result from the use of angiotensin-converting enzyme (ACE) inhibitors, as seen in a study published in 1998 2.
- The use of ACE inhibitors can lead to hyperkalemia, particularly in patients with chronic renal insufficiency, as noted in a 2012 review 3.
- Other factors that can contribute to hyperkalemia include:
- Renal insufficiency
- Congestive heart failure
- Diabetes
- Excessive potassium intake from diet, supplements, or drugs
- Use of loop or thiazide diuretic agents
- Age more than 70 years
- Serum urea nitrogen level higher than 6.4 mmol/L (18 mg/dL) or creatinine level higher than 136 mumol/L (1.5 mg/dL) 2, 3, 4, 5, 6
- Hyperkalemia can also be caused by disruptions in potassium regulation involving intake, excretion, and intracellular-extracellular distribution, particularly in patients with chronic kidney disease (CKD) and heart failure (HF) 6.
Risk Factors for Hyperkalemia
- Patients with CKD are at higher risk of developing hyperkalemia, with the prevalence of hyperkalemia increasing with the stage of CKD 4, 5.
- The use of renin-angiotensin-aldosterone-system blockers, such as ACE inhibitors and angiotensin receptor blockers (ARBs), can increase the risk of hyperkalemia, particularly in patients with CKD or HF 2, 3, 5, 6.
- Other medications, such as potassium-sparing diuretics, can also increase the risk of hyperkalemia 6.