Hyperkalemia in adults

References

Key articles

Alfonzo A, Harrison A, Baines R, et al; UK Kidney Association (formerly the Renal Association). Clinical practice guidelines: treatment of acute hyperkalaemia in adults​. June 2020 [internet publication].Full text

Rafique Z, Peacock F, Armstead T, et al. Hyperkalemia management in the emergency department: an expert panel consensus. J Am Coll Emerg Physicians Open. 2021 Oct;2(5):e12572.Full text  Abstract

Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219.Full text  Abstract

Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. Kidney Int. 2020 Jan;97(1):42-61.Full text  Abstract

Rossignol P, Legrand M, Kosiborod M, et al. Emergency management of severe hyperkalemia: guideline for best practice and opportunities for the future. Pharmacol Res. 2016 Nov;113(pt a):585-91.Full text  Abstract

Reference articles

1. Alfonzo A, Harrison A, Baines R, et al; UK Kidney Association (formerly the Renal Association). Clinical practice guidelines: treatment of acute hyperkalaemia in adults​. June 2020 [internet publication].Full text

2. Rafique Z, Peacock F, Armstead T, et al. Hyperkalemia management in the emergency department: an expert panel consensus. J Am Coll Emerg Physicians Open. 2021 Oct;2(5):e12572.Full text  Abstract

3. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219.Full text  Abstract

4. Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. Kidney Int. 2020 Jan;97(1):42-61.Full text  Abstract

5. Palmer BF, Carrero JJ, Clegg DJ, et al. Clinical management of hyperkalemia. Mayo Clin Proc. 2021 Mar;96(3):744-62.Full text  Abstract

6. Singer AJ, Thode HC Jr, Peacock WF. A retrospective study of emergency department potassium disturbances: severity, treatment, and outcomes. Clin Exp Emerg Med. 2017 Jun;4(2):73-9.Full text  Abstract

7. Aggarwal S, Topaloglu H, Kumar S. Trends in emergency room visits due to hyperkalemia in the United States. Value in Health. 2015 Nov;18(7):PA386.Full text

8. Conway R, Creagh D, Byrne DG, et al. Serum potassium levels as an outcome determinant in acute medical admissions. Clin Med (Lond). 2015 Jun;15(3):239-43.Full text  Abstract

9. Humphrey T, Davids MR, Chothia MY, et al. How common is hyperkalaemia? A systematic review and meta-analysis of the prevalence and incidence of hyperkalaemia reported in observational studies. Clin Kidney J. 2022 Apr;15(4):727-737.Full text  Abstract

10. Sarafidis PA, Blacklock R, Wood E, et al. Prevalence and factors associated with hyperkalemia in predialysis patients followed in a low-clearance clinic. Clin J Am Soc Nephrol. 2012 Aug;7(8):1234-41.Full text  Abstract

11. Cai JJ, Wang K, Jiang HQ, et al. Characteristics, risk factors, and adverse outcomes of hyperkalemia in acute-on-chronic liver failure patients. Biomed Res Int. 2019;2019:6025726.Full text  Abstract

12. Rossignol P, Legrand M, Kosiborod M, et al. Emergency management of severe hyperkalemia: guideline for best practice and opportunities for the future. Pharmacol Res. 2016 Nov;113(pt a):585-91.Full text  Abstract

13. Chan KE, Thadhani RI, Maddux FW. Adherence barriers to chronic dialysis in the United States. J Am Soc Nephrol. 2014 Nov;25(11):2642-8.Full text  Abstract

14. Allon M, Takeshian A, Shanklin N. Effect of insulin-plus-glucose infusion with or without epinephrine on fasting hyperkalemia. Kidney Int. 1993 Jan;43(1):212-7.Full text  Abstract

15. Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. 1995 Oct;6(4):1134-42.Full text  Abstract

16. Palmer BF, Clegg DJ. Hyperkalemia across the continuum of kidney function. Clin J Am Soc Nephrol. 2018 Jan 6;13(1):155-7.Full text  Abstract

17. Bandak G, Sang Y, Gasparini A, et al. Hyperkalemia after initiating renin-angiotensin system blockade: the Stockholm creatinine measurements (SCREAM) project. J Am Heart Assoc. 2017 Jul 19;6(7):e005428.Full text  Abstract

18. Parving HH, Brenner BM, McMurray JJ, et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med. 2012 Dec 6;367(23):2204-13.Full text  Abstract

19. Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med. 2013 Nov 14;369(20):1892-903.Full text  Abstract

20. ONTARGET Investigators; Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008 Apr 10;358(15):1547-59.Full text  Abstract

21. Vukadinović D, Lavall D, Vukadinović AN, et al. True rate of mineralocorticoid receptor antagonists-related hyperkalemia in placebo-controlled trials: a meta-analysis. Am Heart J. 2017 Jun;188:99-108.Full text  Abstract

22. Velázquez H, Perazella MA, Wright FS, et al. Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med. 1993 Aug 15;119(4):296-301. Abstract

23. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2022 May 3;145(18):e895-1032.Full text  Abstract

24. Sever MS, Erek E, Vanholder R, et al. Serum potassium in the crush syndrome victims of the Marmara disaster. Clin Nephrol. 2003 May;59(5):326-33. Abstract

25. Perkins RM, Aboudara MC, Abbott KC, et al. Resuscitative hyperkalemia in noncrush trauma: a prospective, observational study. Clin J Am Soc Nephrol. 2007 Mar;2(2):313-9.Full text  Abstract

26. Schaller MD, Fischer AP, Perret CH. Hyperkalemia: a prognostic factor during acute severe hypothermia. JAMA. 1990 Oct 10;264(14):1842-5. Abstract

27. Chan R, Sealey JE, Michelis MF, et al. Renin-aldosterone system can respond to furosemide in patients with hyperkalemic hyporeninism. J Lab Clin Med. 1998 Sep;132(3):229-35. Abstract

28. Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004 Aug 5;351(6):543-51.Full text  Abstract

29. American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: standards of medical care in diabetes - 2022. Diabetes Care. 2022 Jan 1;45(suppl 1):S175-84.Full text  Abstract

30. Lunney M, Ruospo M, Natale P, et al. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev. 2020 Feb 27;2(2):CD012466.Full text  Abstract

31. Martin N, Manoharan K, Davies C, et al. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev. 2021 May 22;5(5):CD012721.Full text  Abstract

32. Tamirisa KP, Aaronson KD, Koelling TM. Spironolactone-induced renal insufficiency and hyperkalemia in patients with heart failure. Am Heart J. 2004 Dec;148(6):971-8. Abstract

33. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. 2004 Aug 5;351(6):585-92. Abstract

34. Bakris GL, Siomos M, Richardson D, et al. ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. VAL-K Study Group. Kidney Int. 2000 Nov;58(5):2084-92.Full text  Abstract

35. Lachaal M, Venuto RC. Nephrotoxicity and hyperkalemia in patients with acquired immunodeficiency syndrome treated with pentamidine. Am J Med. 1989 Sep;87(3):260-3.Full text  Abstract

36. Schlondorff D. Renal complications of nonsteroidal anti-inflammatory drugs. Kidney Int. 1993 Sep;44(3):643-53.Full text  Abstract

37. Oster JR, Singer I, Fishman LM. Heparin-induced aldosterone suppression and hyperkalemia. Am J Med. 1995 Jun;98(6):575-86. Abstract

38. Baird DP, Hunter RW, Neary JJ. Hyperkalaemia on the surgical ward. BMJ. 2015 Oct 21;351:h5531. Abstract

39. Pei Y, Richardson R, Greenwood C, et al. Extrarenal effect of cyclosporine A on potassium homeostasis in renal transplant recipients. Am J Kidney Dis. 1993 Aug;22(2):314-9. Abstract

40. Hoorn EJ, Walsh SB, McCormick JA, et al. The calcineurin inhibitor tacrolimus activates the renal sodium chloride cotransporter to cause hypertension. Nat Med. 2011 Oct 2;17(10):1304-9. Abstract

41. Bushinsky DA, Gennari FJ. Life-threatening hyperkalemia induced by arginine. Ann Intern Med. 1978 Nov;89(5 pt 1):632-4. Abstract

42. Seto A, Murakami M, Fukuyama H, et al. Ventricular tachycardia caused by hyperkalemia after administration of hypertonic mannitol. Anesthesiology. 2000 Nov;93(5):1359-61.Full text  Abstract

43. Gennari FJ. Hypokalemia. N Engl J Med. 1998 Aug 13;339(7):451-8. Abstract

44. Sica DA. Antihypertensive therapy and its effects on potassium homeostasis. J Clin Hypertens (Greenwich). 2006 Jan;8(1):67-73.Full text  Abstract

45. Borron SW, Bismuth C, Muszynski J. Advances in the management of digoxin toxicity in the older patient. Drugs Aging. 1997 Jan;10(1):18-33. Abstract

46. Gronert GA. Cardiac arrest after succinylcholine: mortality greater with rhabdomyolysis than receptor upregulation. Anesthesiology. 2001 Mar;94(3):523-9.Full text  Abstract

47. Ochoa-Gómez J, Villar-Arias A, Aresti I, et al. A case of severe hyperkalaemia and compartment syndrome due to rhabdomyolysis after drugs abuse. Resuscitation. 2002 Jul;54(1):103-5. Abstract

48. Kalemkerian GP, Darwish B, Varterasian ML. Tumor lysis syndrome in small cell carcinoma and other solid tumors. Am J Med. 1997 Nov;103(5):363-7. Abstract

49. Colussi G, Cipriani D. Pseudohyperkalemia in extreme leukocytosis. Am J Nephrol. 1995;15(5):450-2. Abstract

50. Graber M, Subramani K, Corish D, et al. Thrombocytosis elevates serum potassium. Am J Kidney Dis. 1988 Aug;12(2):116-20. Abstract

51. Saperstein DS. Muscle channelopathies. Semin Neurol. 2008 Apr;28(2):260-9.Full text  Abstract

52. Kovesdy CP, Matsushita K, Sang Y, et al. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. Eur Heart J. 2018 May 1;39(17):1535-42.Full text  Abstract

53. Gasparini A, Evans M, Barany P, et al. Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project. Nephrol Dial Transplant. 2019 Sep 1;34(9):1534-41.Full text  Abstract

54. Sidhu K, Sanjanwala R, Zieroth S. Hyperkalemia in heart failure. Curr Opin Cardiol. 2020 Mar;35(2):150-5.Full text  Abstract

55. DeFronzo RA. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney Int. 1980 Jan;17(1):118-34.Full text  Abstract

56. Cremades A, Del Rio-Garcia J, Lambertos A, et al. Tissue-specific regulation of potassium homeostasis by high doses of cationic amino acids. Springerplus. 2016;5:616.Full text  Abstract

57. Fanous AA, Tick RC, Gu EY, et al. Life-threatening mannitol-induced hyperkalemia in neurosurgical patients. World Neurosurg. 2016 Jul;91:672.e5-9.Full text  Abstract

58. Palmer LG, Frindt G. Regulation of apical K channels in rat cortical collecting tubule during changes in dietary K intake. Am J Physiol. 1999 Nov;277(5):F805-12.Full text  Abstract

59. Harris AN, Grimm PR, Lee HW, et al. Mechanism of hyperkalemia-induced metabolic acidosis. J Am Soc Nephrol. 2018 May;29(5):1411-25.Full text  Abstract

60. Reza MJ, Kovick RB, Shine KI, et al. Massive intravenous digoxin overdosage. N Engl J Med. 1974 Oct 10;291(15):777-8. Abstract

61. Bandara V, Weinstein SA, White J, et al. A review of the natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning. Toxicon. 2010 Sep 1;56(3):273-81. Abstract

62. Statland JM, Fontaine B, Hanna MG, et al. Review of the diagnosis and treatment of periodic paralysis. Muscle Nerve. 2018 Apr;57(4):522-30.Full text  Abstract

63. Nowicki M, Miszczak-Kuban J. Nonselective Beta-adrenergic blockade augments fasting hyperkalemia in hemodialysis patients. Nephron. 2002 Jun;91(2):222-7.Full text  Abstract

64. Poels PJ, Gabreëls FJ. Rhabdomyolysis: a review of the literature. Clin Neurol Neurosurg. 1993 Sep;95(3):175-92.Full text  Abstract

65. Knochel JP. Rhabdomyolysis and myoglobinuria. Annu Rev Med. 1982;33:435-43.Full text  Abstract

66. Morris RC Jr. Renal tubular acidosis. Mechanisms, classification and implications. N Engl J Med. 1969 Dec 18;281(25):1405-13. Abstract

67. Rodríguez Soriano J. Renal tubular acidosis: the clinical entity. J Am Soc Nephrol. 2002 Aug;13(8):2160-70.Full text  Abstract

68. Batlle D, Moorthi KM, Schlueter W, et al. Distal renal tubular acidosis and the potassium enigma. Semin Nephrol. 2006 Nov;26(6):471-8. Abstract

69. Hoffman BF, Suckling EE. Effect of several cations on transmembrane potentials of cardiac muscle. Am J Physiol. 1956 Aug;186(2):317-24. Abstract

70. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011 May 12;364(19):1844-54.Full text  Abstract

71. Choi MJ, Ziyadeh FN. The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. J Am Soc Nephrol. 2008 Mar;19(3):424-6.Full text  Abstract

72. An JN, Lee JP, Jeon HJ, et al. Severe hyperkalemia requiring hospitalization: predictors of mortality. Crit Care. 2012 Nov 21;16(6):R225.Full text  Abstract

73. Khanagavi J, Gupta T, Aronow WS, et al. Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes. Arch Med Sci. 2014 May 12;10(2):251-7.Full text  Abstract

74. Kovesdy CP. Management of hyperkalemia: an update for the internist. Am J Med. 2015 Dec;128(12):1281-7. Abstract

75. Elliott MJ, Ronksley PE, Clase CM, et al. Management of patients with acute hyperkalemia. CMAJ. 2010 Oct 19;182(15):1631-5.Full text  Abstract

76. Resuscitation Council UK. 2021 resuscitation guidelines: special circumstances guidelines. May 2021 [internet publication].Full text

77. Medicines and Healthcare products Regulatory Agency. National patient safety alert: potential risk of underdosing with calcium gluconate in severe hyperkalaemia (NatPSA/2023/007/MHRA)​. June 2023 [internet publication].Full text

78. Batterink J, Cessford TA, Taylor RA. Pharmacological interventions for the acute management of hyperkalaemia in adults. Cochrane Database Syst Rev. 2015 Oct 29;10(10):CD010344.Full text  Abstract

79. Liou HH, Chiang SS, Wu SC, et al. Hypokalemic effects of intravenous infusion or nebulization of salbutamol in patients with chronic renal failure: comparative study. Am J Kidney Dis. 1994 Feb;23(2):266-71. Abstract

80. Blumberg A, Weidmann P, Shaw S, et al. Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure. Am J Med. 1988 Oct;85(4):507-12. Abstract

81. Mahoney BA, Smith WA, Lo DS, et al. Emergency interventions for hyperkalaemia. Cochrane Database Syst Rev. 2005 Apr 18;2005(2):CD003235.Full text  Abstract

82. Geng S, Green EF, Kurz MC, et al. Sodium bicarbonate administration and subsequent potassium concentration in hyperkalemia treatment. Am J Emerg Med. 2021 Dec;50:132-5.Full text  Abstract

83. Blumberg A, Weidmann P, Ferrari P. Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Kidney Int. 1992 Feb;41(2):369-74.Full text  Abstract

84. Allon M, Shanklin N. Effect of bicarbonate administration on plasma potassium in dialysis patients: interactions with insulin and albuterol. Am J Kidney Dis. 1996 Oct;28(4):508-14. Abstract

85. Rafique Z, Liu M, Staggers KA, et al. Patiromer for treatment of hyperkalemia in the emergency department: a pilot study. Acad Emerg Med. 2020 Jan;27(1):54-60.Full text  Abstract

86. Peacock WF, Rafique Z, Vishnevskiy K, et al. Emergency potassium normalization treatment including sodium zirconium cyclosilicate: a phase II, randomized, double-blind, placebo-controlled study (ENERGIZE). Acad Emerg Med. 2020 Jun;27(6):475-86.Full text  Abstract

87. National Institute for Health and Care Excellence. Sodium zirconium cyclosilicate for treating hyperkalaemia. September 2019 [internet publication].Full text

88. National Institute for Health and Care Excellence. Patiromer for treating hyperkalaemia. February 2020 [internet publication].​Full text

89. ClinicalTrials.gov. Patiromer utility as an adjunct treatment in patients needing urgent hyperkalemia management (PLATINUM). NCT04443608. April 2023 [internet publication].Full text

90. Spinowitz BS, Fishbane S, Pergola PE, et al. Sodium xirconium cyclosilicate among individuals with hyperkalemia: a 12-month phase 3 study. Clin J Am Soc Nephrol. 2019 Jun 7;14(6):798-809.Full text  Abstract

91. Bakris GL, Pitt B, Weir MR, et al. Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease: the AMETHYST-DN randomized clinical trial. JAMA. 2015 Jul 14;314(2):151-61.Full text  Abstract

92. Think Kidneys; Renal Association; British Society for Heart Failure​. Changes in kidney function and serum potassium during ACEI/ARB/diuretic treatment in primary care: a position statement from Think Kidneys, the Renal Association, and the British Society for Heart Failure. January 2020 [internet publication].Full text

93. Tromp J, van der Meer P. Hyperkalaemia: aetiology, epidemiology, and clinical significance. Eur Heart J Suppl. 2019 Feb;21(suppl a):A6-11.Full text  Abstract

94. Einhorn LM, Zhan M, Hsu VD, et al. The frequency of hyperkalemia and its significance in chronic kidney disease. Arch Intern Med. 2009 Jun 22;169(12):1156-62.Full text  Abstract

95. McMahon GM, Mendu ML, Gibbons FK, et al. Association between hyperkalemia at critical care initiation and mortality. Intensive Care Med. 2012 Nov;38(11):1834-42.Full text  Abstract

96. Jain N, Kotla S, Little BB, et al. Predictors of hyperkalemia and death in patients with cardiac and renal disease. Am J Cardiol. 2012 May 15;109(10):1510-3.Full text  Abstract

97. Weiss JN, Qu Z, Shivkumar K. Electrophysiology of hypokalemia and hyperkalemia. Circ Arrhythm Electrophysiol. 2017 Mar;10(3):e004667.Full text  Abstract

98. El-Sherif N, Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiol J. 2011;18(3):233-45. Abstract

99. DuBose TD Jr, Good DW. Effects of chronic hyperkalemia on renal production and proximal tubule transport of ammonium in rats. Am J Physiol. 1991 May;260(5 pt 2):F680-7. Abstract

100. Nagami GT. Effect of bath and luminal potassium concentration on ammonia production and secretion by mouse proximal tubules perfused in vitro. J Clin Invest. 1990 Jul;86(1):32-9.Full text  Abstract

101. Arnold R, Pussell BA, Howells J, et al. Evidence for a causal relationship between hyperkalaemia and axonal dysfunction in end-stage kidney disease. Clin Neurophysiol. 2014 Jan;125(1):179-85.Full text  Abstract

102. Arnold R, Pianta TJ, Pussell BA, et al. Randomized, controlled trial of the effect of dietary potassium restriction on nerve function in CKD. Clin J Am Soc Nephrol. 2017 Oct 6;12(10):1569-77.Full text  Abstract

103. Cheng CJ, Chiu JS, Huang WH, et al. Acute hyperkalemic paralysis in a uremic patient. J Nephrol. 2005 Sep-Oct;18(5):630-3. Abstract

104. National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. August 2021 [internet publication].Full text

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