From the Guidelines
Hyperkalemia is primarily caused by impaired potassium excretion by the kidneys, excessive potassium intake, or shifts of potassium from inside cells to the bloodstream, with kidney disease being the most common cause, particularly chronic kidney disease, acute kidney injury, and certain tubular disorders that impair potassium secretion, as noted in the most recent study 1.
Causes of Hyperkalemia
The causes of hyperkalemia can be categorized into three main groups:
- Impaired potassium excretion by the kidneys, which can be due to kidney disease, such as chronic kidney disease, acute kidney injury, and certain tubular disorders that impair potassium secretion 1.
- Excessive potassium intake, which can be due to supplements, salt substitutes, or blood transfusions 1.
- Shifts of potassium from inside cells to the bloodstream, which can be due to conditions like acidosis, insulin deficiency, hyperglycemia, tissue damage, and certain medications such as succinylcholine and digoxin toxicity 1.
Medications that Contribute to Hyperkalemia
Medications can significantly contribute to hyperkalemia, especially:
- ACE inhibitors
- Angiotensin receptor blockers (ARBs)
- Potassium-sparing diuretics (spironolactone, eplerenone, amiloride)
- NSAIDs
- Beta-blockers
- Heparin
- Trimethoprim
- Calcineurin inhibitors like cyclosporine and tacrolimus 1.
Importance of Monitoring
Monitoring of serum creatinine and potassium is crucial after initiation of treatment with ACE inhibitors, ARBs, MRAs, or diuretics, and during treatment, particularly among individuals with reduced glomerular filtration who are at increased risk of hyperkalemia and acute kidney injury 1.
From the Research
Causes of Hyperkalemia
Hyperkalemia, or elevated potassium levels, can be caused by various factors, including:
- Kidney disease, as the kidneys play a crucial role in regulating potassium levels in the body 2, 3, 4, 5
- Medication use, such as angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, and potassium-sparing diuretics 2, 6
- Hyperglycemia, or high blood sugar levels 2
- Transcellular shifts, where potassium moves from cells into the bloodstream 2, 4
- Decreased renal potassium excretion, which can be caused by various factors, including kidney disease and certain medications 3, 6
Mechanisms of Hyperkalemia
Hyperkalemia can occur through several mechanisms, including:
- Impaired renal potassium excretion, which can be caused by kidney disease or certain medications 3, 6
- Transcellular potassium shift, where potassium moves from cells into the bloodstream 2, 4
- Increased potassium supply, which can be caused by certain medications or dietary factors 6
Clinical Significance of Hyperkalemia
Hyperkalemia can lead to serious clinical consequences, including: