The American Journal of Medicine
Volume 122, Issue 3 , Pages 215-221 , March 2009

The Management of Hyperkalemia in Patients with Cardiovascular Disease

  • Apurv Khanna, MD

      Affiliations

    • Corresponding Author InformationRequests for reprints should be addressed to Apurv Khanna, MD, Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3940
  • ,
  • William B. White, MD

References 

  1. Shilpak MG. Pharmacotherapy for heart failure in patients with renal insufficiency. Ann Intern Med. 2003;138:917–924
  2. Rodrigues EJ, Eisenberg MJ, Pilote L. Effects of early and late administration of angiotensin-converting enzyme inhibitors on mortality after myocardial infarction. Am J Med. 2003;115:473–479
  3. Brenner BM, Cooper ME, de Zeeuw D, et al. RENAAL Study Investigators Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861–869
  4. Sarnak MJ, Levey AS, Schoolwerth A, et al. American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–2169
  5. Putcha N, Allon M. Management of hyperkalemia in dialysis patients. Semin Dial. 2007;20:431–439
  6. Sweadner KJ, Goldin SM. Active transport of sodium and potassium ions: Mechanism, function and regulation. N Engl J Med. 1980;302:777–783
  7. Stanton BA. Regulation of Na+ and K+ transport by mineralocorticoids. Semin Nephrol. 1987;7:82–90
  8. Illingworth RN, Proudfoot AT. Rapid poisoning with slow-release potassium. Br Med J. 1980;2:485–486
  9. Restuccio A. Fatal hyperkalemia from a salt substitute. Am J Emerg Med. 1992;10:171–173
  10. Bay WH, Hartman JA. High potassium in low sodium soups. N Engl J Med. 1983;308:1166–1167
  11. Rose BD, Post TW. Hyperkalemia. In:  Rose BD,  Post TW editor. Clinical Physiology of Acid-base and Electrolyte Disorders. New York, NY: McGraw-Hill; 2001;p. 888–930
  12. Castellino P, Bia MJ, DeFronzo RA. Adrenergic modulation of potassium metabolism in uremia. Kidney Int. 1990;37:793–798
  13. Aperia A. New roles for old enzyme: Na,K-ATPase emerges as an interesting drug target. J Intern Med. 2007;261:44–52
  14. Reza MJ, Kovick RB, Shine KI, Pearce ML. Massive intravenous digoxin overdosage. N Engl J Med. 1974;291:777–778
  15. Kao YJ, Mian T, Kleinman S, Racz GB. Hyperkalemia: a complication of warm heart surgery. Can J Anesth. 1993;4067-:4070
  16. Adrogue HJ, Madias NE. Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med. 1981;71:456–467
  17. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. 2004;351:585–592
  18. Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. 1995;6:1134–1142
  19. Ramadan FH, Masoodi N, El-Solh AA. Clinical factors associated with hyperkalemia in patients with congestive heart failure. J Clin Pharm Ther. 2005;30:233–239
  20. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709–717
  21. Sligl W, McAlister FA, Ezekowitz J, et al. Usefulness of spironolactone in a specialized heart failure clinic. Am J Cardiol. 2004;94:443–447
  22. Textor SC, Bravo EL, Fouad FM, Tarazi RC. Hyperkalemia in azotemic patients during angiotensin-converting enzyme inhibition and aldosterone reduction with captopril. Am J Med. 1982;73:719–725
  23. Shier DN, Kusano E, Stoner GD, et al. Production of renin, angiotensin II, and aldosterone by adrenal explant cultures: response to potassium and converting enzyme inhibition. Endocrinology. 1989;125:486–491
  24. Burgess E. Eplerenone in hypertension. Expert Opin Pharmcother. 2004;5:2573–2581
  25. Cruz CS, Cruz AA, deSouza CAM. Hyperkalemia in congestive heart failure patients using ACE inhibitors and spironolactone. Nephrol Dial Transplant. 2003;18:1814–1819
  26. Horisberger JD, Giebisch G. Potassium sparing diuretics. Renal Physiol. 1987;10:198–220
  27. Juurlink DN, Mamdani M, Kopp A, et al. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289:1652–1658
  28. Oster JR, Singer I, Fishman LM. Heparin induced aldosterone suppression and hyperkalemia. Am J Med. 1995;98:575–586
  29. Deray G. Renal and cardiovascular effects of non-steroidal anti-inflammatory and selective cox-2 inhibitors. Presse Med. 2004;33:483–489
  30. Campbell WB, Gomez-Sanchez CE, Adams BV, et al. Attenuation of angiotensin II and III induced aldosterone release by prostaglandin synthesis inhibitors. J Clin Invest. 1979;64:1552–1557
  31. Zimran A, Dramer M, Plaskin , Hershko C. Incidence of hyperkalemia induced by indomethacin in a hospital population. Br Med J. 1985;291:107–108
  32. Parving HH, Persson F, Lewis JB, et al. AVOID Study Investigators Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med. 2008;358:2433–2446
  33. McMurray JJ, Ostergren J, Swedberg K, et al. CHARM Investigators and Committees Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting enzyme inhibitors: the CHARM-Added trial. Lancet. 2003;362:767–771
  34. Yusuf S, Teo KK, Pogue J, et al. ONTARGET Investigators Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–1559
  35. Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Hyperkalemia revisited. Tex Heart Inst J. 2006;33:40–47
  36. Muensterer OJ. Hyperkalemic paralysis. Age Ageing. 2003;32:114–115
  37. Alfonzo AV, Isles C, Geddes C, Deighan C. Potassium disorders—clinical spectrum and emergency management. Resuscitation. 2006;70:10–25
  38. Winkler AW, Hoff HE, Smith PK. Factors affecting the toxicity of potassium. Am J Physiol. 1939;127:430–435
  39. Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. 1990;38:869–872
  40. Salem MM, Rosa RM, Batlle DC. Extrarenal potassium tolerance in chronic renal failure. Am J Kidney Dis. 1991;18:421–440
  41. Ahee PP, Crowe AV. The management of hyperkalemia in the emergency department. J Accid Emerg Med. 2000;17:188–191
  42. Pancu D, LaFlamme M, Evans E, Reed J. Levalbuterol is as effective as racemic albuterol in lowering serum potassium. J Emerg Med. 2003;25:13–16
  43. Kamel SK, Wei C. Controversial issues in the treatment of hyperkalemia. Nephrol Dial Transplant. 2003;18:2215–2218
  44. Gruy-Kapral C, Emmett M, Santa Ana CA, et al. Effect of single dose resin-cathartic therapy on serum potassium concentration in patients with end-stage renal failure. J Am Soc Nephrol. 1998;10:1924–1930
  45. Zehnder C, Gutzwiller JP, Huber A, et al. Low potassium and glucose free dialysis maintains urea but enhances potassium removal. Nephrol Dial Transplant. 2001;16:78–84
  46. Ray K, Dorman S, Watson R. Severe hyperkalemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens. 1999;13:717–720
  47. Meneton P, Loffing J, Warnock D. Sodium and potassium handling by the aldosterone-sensitive distal nephron: the pivotal role of the distal and connecting tubule. Am J Physiol. 2004;56:593–601
  48. Vasavada N, Saha C, Agarwal R. A double-blind randomized crossover trial of two loop diuretics in chronic kidney disease. Kidney Int. 2003;64:632–640
  49. Fraley DS, Adler S. Correction of hyperkalemia by bicarbonate despite constant blood pH. Kidney Int. 1977;12:354–360
  50. Palmer BF. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: what to do if the serum creatinine and/or serum potassium rises. Nephrol Dial Transplant. 2003;18:1973–1975

 Funding: This work was supported in part by funding from US Department of Defense DAMDW81XWH-05-10060, NIH R01 AG022092, and an unrestricted educational grant from Boehringer-Ingelheim Pharmaceuticals.

 Conflict of Interest: Dr White discloses that he has received research funding during the previous 12 months from the National Institutes of Health, the Catherine and Patrick Donaghue Foundation, Astra-Zeneca Pharmaceuticals, Inc, Boehringer-Ingelheim Pharmaceuticals, Inc, Novartis, Inc, and Pfizer, Inc. Dr White serves as a safety consultant to Gilead, Inc, Nicox, Inc, Palatin Technologies, Takeda Research Development Group, and Teva Neurosciences, Inc. Dr Khanna discloses he has received an unrestricted educational grant from Boehringer-Ingelheim Pharmaceuticals.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(08)01119-4

doi: 10.1016/j.amjmed.2008.10.028

The American Journal of Medicine
Volume 122, Issue 3 , Pages 215-221 , March 2009