Management of Hyperkalemia: An Update for the Internist

  • Csaba P. Kovesdy
    Requests for reprints should be addressed to Csaba P. Kovesdy, MD, FASN, University of Tennessee Health Science Center, 956 Court Ave., Memphis TN 38163.
    University of Tennessee Health Science Center, Memphis, Tenn
    Memphis VA Medical Center, Memphis, Tenn
    Search for articles by this author


      Hyperkalemia is a clinically important electrolyte abnormality that occurs most commonly in patients with chronic kidney disease. Due to its propensity to induce electrophysiological disturbances, severe hyperkalemia is considered a medical emergency. The management of acute and chronic hyperkalemia can be achieved through the implementation of various interventions, one of which is the elimination of medications that can raise serum potassium levels. Because many such medications (especially inhibitors of the renin-angiotensin aldosterone system) have shown beneficial effects in patients with cardiovascular and renal disease, their discontinuation for reasons of hyperkalemia represent an undesirable clinical compromise. The emergence of 2 new potassium-binding medications for acute and chronic therapy of hyperkalemia may soon allow the continued use of medications such as renin-angiotensin-aldosterone system inhibitors even in patients who are prone to hyperkalemia. This review article provides an overview of the physiology and the pathophysiology of potassium metabolism and hyperkalemia, the epidemiology of hyperkalemia, and its acute and chronic management. We discuss in detail emerging data about new potassium-lowering therapies, and their potential future role in clinical practice.


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      Linked Article

      • Management of Hyperkalemia: Put It into Context
        The American Journal of MedicineVol. 129Issue 7
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          I read the article by Kovesdy1 published in the December 2015 issue of The American Journal of Medicine with great interest. The author summarized the recent literature on the clinical approach, and management of, hyperkalemia. Indeed, hyperkalemia represents a true metabolic emergency necessitating prompt assessment and correction. However, I believe that several aspects of hyperkalemia management should be mentioned. I will briefly discuss my clinical approach in the management of patients with hyperkalemia.
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