From the Guidelines
To manage hyperkalemia, it is essential to focus on dietary changes, medication adjustments, and treating underlying conditions, with the goal of reducing potassium levels and preventing complications, as recommended by the most recent and highest quality study 1.
Indications for Reducing Hyperkalemia
The indications for reducing hyperkalemia include:
- High-potassium foods in the diet, such as bananas, oranges, potatoes, and leafy greens
- Medications that can raise potassium levels, such as ACE inhibitors, ARBs, or potassium-sparing diuretics
- Underlying conditions like kidney disease or Addison's disease that may be causing high potassium
- Severe cases of hyperkalemia that require emergency treatments like intravenous calcium gluconate, insulin with glucose, or dialysis
Steps to Lower Potassium Levels
Here are specific steps to lower potassium levels:
- Reduce high-potassium foods in the diet
- Increase water intake to help flush excess potassium through urine
- If prescribed, take potassium-binding medications like sodium polystyrene sulfonate (Kayexalate) or patiromer (Veltassa) as directed by the doctor
- Adjust or discontinue medications that can raise potassium levels under medical supervision
- Treat underlying conditions like kidney disease or Addison's disease that may be causing high potassium
- In severe cases, emergency treatments like intravenous calcium gluconate, insulin with glucose, or dialysis may be necessary
Importance of Monitoring and Adjusting Treatment
It is crucial to follow the doctor's advice and monitor potassium levels regularly, as potassium balance is vital for proper heart and muscle function, and to protect against development of hypokalaemia, which may be even more dangerous than hyperkalaemia, as noted in the expert consensus document 1. The use of newer K+ binders, such as patiromer sorbitex calcium and sodium zirconium cyclosilicate, may facilitate optimization of RAASi therapy and more effective management of hyperkalemia, as suggested by recent clinical studies 1.
From the FDA Drug Label
LOKELMA is a potassium binder indicated for the treatment of hyperkalemia in adults. Veltassa is a potassium binder indicated for the treatment of hyperkalemia in adults and pediatric patients ages 12 years and older. The indications for reducing hyperkalemia (elevated potassium levels) are:
- Treatment of hyperkalemia in adults using sodium zirconium cyclosilicate (LOKELMA) 2 or patiromer (Veltassa) 3
- Treatment of hyperkalemia in pediatric patients ages 12 years and older using patiromer (Veltassa) 3
From the Research
Indications for Reducing Hyperkalemia
The indications for reducing hyperkalemia include:
- Stabilizing cell membrane potential to prevent life-threatening cardiac and neuromuscular alterations 4, 5, 6
- Promoting transcellular potassium shift to lower serum potassium levels 4, 5, 6
- Lowering total body potassium content through dialysis, increased urinary excretion, or gastrointestinal elimination 4, 5, 6, 7, 8
- Managing acute hyperkalemia, which requires immediate attention due to potentially life-threatening manifestations 8
- Managing chronic hyperkalemia, which develops over a more extended period and is associated with increased morbidity and mortality 8
Treatment Approaches
Treatment approaches for hyperkalemia include:
- Elimination of medications that can raise serum potassium levels, such as renin-angiotensin-aldosterone system inhibitors 5, 8
- Use of potassium-binding medications, such as patiromer and sodium zirconium cyclosilicate, to increase gastrointestinal potassium elimination 4, 5, 7
- Use of diuretics to increase urinary potassium excretion 7, 8
- Hemodialysis to remove excess potassium from the body 7
- Dietary restriction of nonplant sources of potassium to manage hyperkalemia 8