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. 2025 Apr 29;18(5):sfaf127.
doi: 10.1093/ckj/sfaf127. eCollection 2025 May.

The burden of hyperkalaemia in chronic kidney disease: a systematic literature review

Jürgen Floege  1 , Andrew H Frankel  2 , Kevin F Erickson  3 , Ketevan Rtveladze  4 , Yogesh Punekar  4 , Jahangir Nabi Mir  5 , Jessica Walters  4 , Alexandra Ehm  6 , James Fotheringham  7
Affiliations

The burden of hyperkalaemia in chronic kidney disease: a systematic literature review

Jürgen Floege et al. Clin Kidney J. .

Abstract

Background: The global epidemiology and burden of hyperkalaemia in patients with chronic kidney disease (CKD) are unclear due to the inconsistent definitions of hyperkalaemia. The combination of adverse effects and interaction between comorbidity and pharmacotherapies, such as renin-angiotensin-aldosterone system inhibitors (RAASi), justify a systematic understanding of this common complication of CKD.

Methods: This systematic literature review aimed to identify and descriptively summarize the evidence on hyperkalaemia risk factors and associated characteristics in adult CKD patients, including the effects of sub-optimal RAASi. Medline® and Embase® databases were searched from January 2000 to April 2024, with additional hand searching. Publications were screened by two independent reviewers. Data were extracted by one reviewer and verified by another reviewer; study quality assessment was also conducted.

Results: A total of 138 studies described in 145 publications met the eligibility criteria. The published literature revealed varying prevalence of hyperkalaemia amongst inconsistent definitions and a significant increase in the prevalence and incidence of hyperkalaemia among patients with CKD, regardless of RAASi treatment. Hyperkalaemia was associated with adverse outcomes and increased hospital resource use. Additionally, studies pointed to negative health and economic outcomes due to sub-optimal RAASi dosing in CKD patients with hyperkalaemia, as well as in those with CKD and comorbid heart failure.

Conclusions: This review expands on current research, offering a new perspective specifically focused on CKD patients and wider clinical and economic outcomes. Identification of wider clinical and economic consequences of hyperkalaemia in CKD patients, and the interplay between these risks and the risks of sub-optimal RAASi dosing, justify the need for future research. Clinicians should exercise caution when managing this condition in this complex patient group.

Keywords: CKD; RAASi; epidemiology; health and economic outcomes; hyperkalaemia; sub-optimal dosing.

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Conflict of interest statement

J. Floege has received consultancy and/or lecture honoraria from AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, CSL Vifor, GSK, Novartis, Otsuka, Roche, Stadapharm and Travere. J. Fotheringham has conducted research for AstraZeneca and CSL Vifor. A.H.F. has received research grants, prepared educational materials, and attended drug advisory boards from/for Boehringer Ingelheim, Lilly, AstraZeneca, Menarani, Bayer and Apacor. K.F.E. has received consulting fees from Boehringer Ingelheim. K.R., Y.P. and J.N.M. are employees of IQVIA, which received funds from Boehringer Ingelheim for the conduct of this work.

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