Review Article

A Brief Review of the Pharmacology of Hyperkalemia: Causes and Treatment

Authors: James M. Wooten, PharmD, Fernanda E. Kupferman, MD, Juan C. Kupferman, MD, MPH

Abstract

Hyperkalemia is a common problem in both inpatients and outpatients. Many disease states (eg, chronic kidney disease) and medications may precipitate hyperkalemia. There are several drugs now available to treat hyperkalemia. Many of these drugs are relatively new. This review provides information regarding drug-induced causes of hyperkalemia and provides detailed information on the medications used to treat this problem.

 

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Ringer J, Bartlett Y. The significance of potassium. Pharm J 2007;278:497-500.
2. Ingelfinger JR. A new era for the treatment of hyperkalemia? N Engl J Med 2015;372:275-277.
3. Palmer BF. Regulation of potassium homeostasis. Clin J Am Soc Nephrol 2015;10:1050-1060.
4. Dunn JD, Benton WW, Orozco-Torrentera E, et al. The burden of hyperkalemia in patients with cardiovascular and renal disease. Am J Manag Care 2015;21(15 suppl):s307-s315.
5. Cheng CJ, Kuo E, Huang CL. Extracellular potassium homeostasis: insights from hypokalemic periodic paralysis. Semin Nephrol 2013;33:237-247.
6. Hoskote SS, Joshi SR, Ghosh AK. Disorders of potassium homeostasis: pathophysiology and management. J Assoc Physicians India 2008;56:685-693.
7. Dhondup T, Qian Q. Electrolyte and acid-base disorders in chronic kidney disease and end-stage kidney failure. Blood Purif 2017;43:179-188.
8. Montague BT, Ouellette JR, Buller GK. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol 2008;3:324-330.
9. Abuelo JG. Treatment of severe hyperkalemia: confronting 4 fallacies. Kidney Int Rep 2018;3:47-55.
10. Kokot F, Hyla-Klekot L. Drug-induced abnormalities of potassium metabolism. Pol Arch Med Wewn 2008;118:431-434.
11. Ben Salem C, Badreddine A, Fathallah N, et al. Drug-induced hyperkalemia. Drug Saf 2014;37:677-692.
12. De Rosales AV, Siripala DS, Bodana S, et al. Pseudohyperkalemia: look before you treat. Saudi J Kidney Dis Transpl 2017;28:410-414.
13. Viera AJ, Wouk N. Potassium disorders: hypokalemia and hyperkalemia. Am Fam Physician 2015;92:487-495.
14. Ng KE, Lee C-S. Updated treatment options in the management of hyperkalemia. US Pharm 2017;42:HS15-HS18.
15. Palmer BF, Clegg DJ. Diagnosis and treatment of hyperkalemia. Clev Clin J Med 2017;84:934-942.
16. Weisberg LS. Management of severe hyperkalemia. Crit Care Med 2008;36:3246-3251.
17. Hollander-Rodriguez JC, Calvert JF. Hyperkalemia. Am Fam Physician 2006;73:283-290.
18. Mahoney BA, Smith WA, Lo DS, et al. Emergency interventions for hyperkalemia. Cochrane Database Syst Rev 2005;2: CD003235.
19. Sarwar CMS, Papadimitriou L, Pitt B, et al. Hyperkalemia in heart failure. J Am Coll Cardiol 2016;68:1575-1589.
20. McCullough PA, Costanzo MR, Silver M, et al. Novel agents for the prevention and management of hyperkalemia. Rev Cardiovasc Med 2015;16:140-155.
21. Rafique Z, Weir MR, Onuigbo M, et al. Expert panel recommendations for the identification and management of hyperkalemia and role of patiromer in patients with chronic kidney disease and heart failure. J Manag Care Spec Pharm 2017;23(suppl 4-a):S10-S19.
22. Fried L, Kovesdy CP, Palmer BF. New options for the management of chronic hyperkalemia. Kidney Int Suppl 2017;7:164-170.
23. 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;314:151-161.
24. Weir MR, Bakris GL, Bushinsky DA, et al. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med 2015;372:211-221.
25. Kosiborod M, Rasmussen HS, Lavin P, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA 2014;312:2223-2233.
26. Horn JR, Hansten JD. Diuretics, ACEIs, ARBs, and NSAIDs: a nephrotoxic combination. https://www.pharmacytimes.com/publications/issue/2013/april2013/diuretics-aceis-arbs-and-nsaids-a-nephrotoxic-combination. Published April 18, 2013. Accessed August 2, 2018.
27. Horn JR, Hansten PD. Hyperkalemia due to drug interactions. http://www.hanstenandhorn.com/hh-article01-04.pdf. Published January 2004. Accessed August 10, 2018.
28. Hughes H, Kahl L, Johns Hopkins Hospital.et al. The Harriet Lane Handbook. 21st ed. Philadelphia:Elsevier;2018.
29. Daly K, Farrington E. Hypokalemia and hyperkalemia in infants and children: pathophysiology and treatment. J Pediatr Health Care 2013;27:486-498.
30. Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol 2011;26:377-384.