What causes hyperkalemia (elevated potassium levels)?

From the Guidelines

Hyperkalemia, or elevated potassium levels, can occur due to various reasons, including kidney disease, certain medications, tissue damage, metabolic acidosis, and excessive consumption of potassium-rich foods or supplements, as supported by the most recent evidence from 1. The causes of hyperkalemia can be categorized into several groups, including:

• Kidney disease, which impates the body's ability to eliminate excess potassium
• Certain medications, such as ACE inhibitors, angiotensin receptor blockers, potassium-sparing diuretics, and non-steroidal anti-inflammatory drugs
• Tissue damage, such as burns or trauma, which can release potassium from damaged cells
• Metabolic acidosis, which can cause potassium to move from the interior to the exterior of cells
• Excessive consumption of potassium-rich foods or supplements
• Hemolysis during blood sampling, which can result in a false elevated reading The treatment of hyperkalemia depends on the underlying cause and may include:
• Dietary restriction of potassium
• Adjustment of medications
• Diuretics, such as loop diuretics
• Resins that exchange potassium for other ions, such as polystyrene sulfonate
• In severe cases, dialysis may be necessary, as noted in 1 and 1. It is essential to note that the risk of hyperkalemia increases with the severity of kidney disease, and patients with advanced chronic kidney disease or heart failure are more likely to experience hyperkalemia, as stated in 1 and 1. In clinical practice, hyperkalemia can be managed by monitoring potassium levels, adjusting medications, and implementing dietary restrictions, as recommended in 1.

From the Research

Causes of Hyperkalemia

• Hyperkalemia is a condition where serum potassium levels exceed 5.5 mmol/l, and it can be caused by certain medical conditions, such as:
  • Chronic kidney disease (CKD) 2, 3, 4, 5
  • Diabetes mellitus 2
• Other factors that can contribute to hyperkalemia include:
  • Medications that raise serum potassium levels, such as inhibitors of the renin-angiotensin aldosterone system 3
  • Renin-angiotensin-aldosterone system (RAAS) inhibitors 4

Underlying Mechanisms

• Hyperkalemia can interfere with cellular function, electrical action potentials, and cellular processes, even at slightly elevated serum potassium levels 4
• Potassium plays a key role in determining the transmembrane potentials of "excitable membranes" present in nerve and muscle cells, and clinical deterioration typically ensues when patients develop marked elevation in extracellular fluid concentrations of potassium (hyperkalemia) 6

Patient Populations at Risk

• Patients with end-stage renal disease (ESRD) on maintenance dialysis have a high risk of developing hyperkalemia 5
• Patients on renin-angiotensin-aldosterone system (RAAS) inhibitors are also at risk of developing hyperkalemia 4