Hyperkalemia in chronic kidney disease

In chronic kidney disease, excretion of potassium (K+) in the urine is impaired. Levels may also rise with ACE inhibitors and ARBs used to treat hypertension or with use of spironolactone. Levels consistently above 6.0 mmol/l are concern and should be managed. Hyperkalemia, especially levels > 6.5 mmol/l, predisposes to cardiac arrythmias.

Management:

• Low K+ diet
• Correct metabolic acidosis (target serum HCO3 > 22 mmol/l)
• Potassium wasting diuretics (e.g. thiazides)
• Avoid salt substitutes which may be high in K+
• Cease ACE inhibitors/ARBs/Spironolactone if K+ persistently >6.0 mmol/l and not responsive to above therapies
• Refer to nearest emergency departement if K+>6.5 mmol/l