Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Mayo Clin Proc. 2021 Mar;96(3):744-762. doi: 10.1016/j.mayocp.2020.06.014. Epub 2020 Nov 5.
Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K-binding agents. Monitoring serum K should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K-binding agents requires further study to establish whether stringent dietary K restrictions are needed in patients receiving K-binder therapy. Individualized monitoring of serum K among patients with an increased risk of hyperkalemia and the use of newer K-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia.
高钾血症是一种具有潜在生命威胁的电解质异常。尽管有各种指南，但对于高钾血症的监测，没有普遍接受的最佳实践共识，包括钾（K）浓度阈值的精确性差异，或者急性或慢性高钾血症的管理。基于现有证据，本综述确定了高钾血症管理方面的几个关键问题和未满足的需求。需要进行真实世界的研究，以便更好地了解临床试验环境之外高钾血症的流行情况。需要改进高钾血症的有效管理，包括分类和 K 监测、何时重新开始已停用的肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗，以及何时使用口服 K 结合剂。监测血清 K 应该个体化；然而，对于慢性肾脏病、糖尿病、心力衰竭或高钾血症病史的患者，以及接受 RAASi 治疗的患者，应考虑增加监测频率。最近的临床研究表明，新型 K 结合剂（聚磺苯乙烯钙和硅酸锆钠环糊精）可能有助于优化 RAASi 治疗。提高初级保健医生和内科医生对这些新型 K 结合剂安全性特征的认识，可能会增加他们管理高钾血症患者的信心。最后，新型 K 结合剂的可用性需要进一步研究，以确定在接受 K 结合剂治疗的患者中是否需要严格限制膳食 K。对于高钾血症风险增加的患者进行个体化的血清 K 监测和使用新型 K 结合剂，可能有助于优化 RAASi 治疗和更有效地管理高钾血症。
