Is hyperkalemia (elevated potassium level) worrisome?

From the Guidelines

A potassium level of 5.5 mmol/L is considered mildly elevated and warrants attention, but immediate action is not necessarily required unless accompanied by symptoms. In patients with potassium levels between 4.5 and 5 mEq/L, not on maximum tolerated, guideline-recommended target dose of RAASi therapy, it is recommended to titrate/start RAASi therapy and closely monitor K+ levels 1. If K+ levels raise above 5.0 mEq/L, K+ lowering measures should be initiated, and in patients with K+ levels >5 on maximum tolerated, guideline-recommended dose of RAASi therapy, treatment with a K+ lowering agent may be initiated as soon as K+ levels >5 mEq/L 1. Some key considerations include:

• Monitoring potassium levels closely
• Adjusting medications that may contribute to hyperkalemia
• Avoiding high-potassium foods
• Staying hydrated unless otherwise instructed by a healthcare provider
• Being aware of symptoms of hyperkalemia such as muscle weakness, numbness, tingling, nausea, or irregular heartbeat, which require immediate medical attention. Given the potential risks associated with hyperkalemia, particularly its impact on heart rhythm, it is crucial to follow up with a healthcare provider within 24 hours to discuss the appropriate course of action.

From the Research

Potassium Levels and Hyperkalemia

• A serum potassium level of 5.5 mmol/L is considered high and may be a sign of hyperkalemia, a condition that can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction 2.
• Hyperkalemia is generally defined as serum potassium concentrations of >5.0 mmol/L, and patients with end-stage renal disease (ESRD) on maintenance dialysis are at high risk of developing hyperkalemia 3.

Management of Hyperkalemia

• Insulin and glucose are frequently used to manage patients with hyperkalemia, but hypoglycemia after insulin use is a frequent complication during hyperkalemia management 4.
• The key approaches to the management of hyperkalemia in patients with ESRD are dialysis, dietary K+ restriction, and avoidance of medications that increase hyperkalemia risk 3.

Association between Serum Potassium and Outcomes

• There is a U-shaped association between serum potassium and mortality, with both hyperkalemia and hypokalemia being independently associated with higher rates of death, major adverse cardiovascular events, hospitalization, and discontinuation of RAAS blockers in patients with chronic kidney disease (CKD) 5.
• The risk of hyperkalemia is linked to dietary potassium intake, level of kidney function, concomitant diseases that may affect potassium balance, and use of medications that influence potassium excretion 6.

Risk Predictors for Hyperkalemia

• An estimated glomerular filtration rate of less than 45 mL/min/1.73 m(2) and a serum potassium level greater than 4.5 mEq/L in the absence of blockers of the renin-angiotensin-aldosterone system (RAAS) are risk predictors for developing hyperkalemia 6.
• Dual RAAS blockade involving any combination of an angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, renin inhibition, or aldosterone-receptor blocker markedly increases the risk of hyperkalemia in patients with stage 3 or higher CKD 6.