Recent Progresses in Non-Dialysis Chronic Kidney Disease Patients with Hyperkalemia: Outcomes and Therapeutic Strategies

Abstract

Chronic kidney disease (CKD) affects about 10% of the world's population. Hyperkalemia is a life-threatening complication in patients with CKD, as it is associated with adverse cardiovascular and kidney outcomes. There are still many challenges and questions to address to improve the currently available therapeutic strategies to treat hyperkalemia, such as how to approach the emergency management of hyperkalemia. In recent years, in addition to novel oral potassium binders, great progress has been made in the application of novel kidney protective strategies, such as mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors (SGLT2i) in hyperkalemia therapy. This review will discuss the recent advances from clinical trials in the effective management of hyperkalemia in non-dialysis CKD patients, enhancing the knowledge of physicians and internists concerning these newer agents and providing a helpful reference for clinical practice.

Keywords: chronic kidney disease; hyperkalemia; potassium.

Figure 1

The harmful effects of hyperkalemia in non-dialysis chronic kidney patients. Cerebrovascular death, neuropathy, cardiovascular death, sudden death, heart failure, and renal failure are highlighted in red, meaning that they are very dangerous; arrhythmia and falls are highlighted in yellow, meaning that they are moderately dangerous; nausea, abdominal pain, dysesthesia, loss of sensation, weakness, and abnormalities of gait are highlighted in green, meaning that they are generally dangerous.

Figure 2

Recommendations for the management of hyperkalemia in non-dialysis chronic kidney disease patients. First, the severity of hyperkalemia is graded according to the plasma level of potassium. For mild hyperkalemia stage, restrict potassium intake to less than 2400 mg/day. For moderate hyperkalemia or severe hyperkalemia, in any hyperkalemic patients presenting with ECG changes suggesting hyperkalemia, treatment must be implemented for stabilizing the cell membrane drug; then, potassium elimination can be used according to the level of serum hyperkalemia. The ECG and serum hyperkalemia should be monitored promptly.