AlSahow Ali, Bulbanat Bassam, Alhelal Bassam, Alhumoud Khaldoun, Alkharaza Ahmad, Alotaibi Torki, Alrajab Heba, Alyousef Anas, Hadi Fatimah
Nephrology division, Jahra Hospital, Al Jahra, Kuwait.
Cardiac Center, Amiri Hospital, Kuwait City, Kuwait.
Int J Nephrol Renovasc Dis. 2024 Oct 5;17:227-240. doi: 10.2147/IJNRD.S476344. eCollection 2024.
Hyperkalemia is common in heart failure (HF) patients on renin angiotensin aldosterone inhibitors (RAASi), in chronic kidney disease (CKD), and in hemodialysis, and it negatively impacts their management. New potassium binders, such as sodium zirconium cyclosilicate (SZC), are effective in management of acute and chronic hyperkalemia. However, guidelines inconsistencies and lack of standardized treatment protocols are hindering proper and wider use of such agents. Therefore, an expert panel from Kuwait developed a consensus statement to address hyperkalemia management in acute settings, in HF, in CKD, and in hemodialysis.
A three-step modified Delphi method was adopted to develop the present consensus, which consisted of two rounds of voting and in-between a virtual meeting. Twelve experts from Kuwait participated in this consensus. Statements were developed and shared with experts for voting. A meeting was held to discuss statements that did not reach consensus at the first round and then the remaining statements were shared for final voting.
The consensus consists of 44 statements involving an introduction to and the management of hyperkalemia in acute settings, HF, CKD, and hemodialysis. Thirty-six statements approved unanimously in the first vote. In the second vote, four statements were removed and four were approved after editing.
Hyperkalemia management lacks standardized definitions, treatment thresholds and consistent guidelines and laboratory practices. This consensus is in response to lack of standardized treatment in the Arabian Gulf, and it aims to establish guidance on hyperkalemia management for healthcare practitioners in Kuwait and highlight future needs.
高钾血症在使用肾素-血管紧张素-醛固酮抑制剂（RAASi）的心力衰竭（HF）患者、慢性肾脏病（CKD）患者以及血液透析患者中很常见，并且会对他们的治疗产生负面影响。新型钾结合剂，如环硅酸锆钠（SZC），在急性和慢性高钾血症的治疗中有效。然而，指南不一致以及缺乏标准化的治疗方案阻碍了此类药物的正确和广泛使用。因此，科威特的一个专家小组制定了一项共识声明，以解决急性情况下、HF、CKD和血液透析中的高钾血症管理问题。
采用三步改良德尔菲法制定本共识，包括两轮投票以及两轮投票之间的一次虚拟会议。来自科威特的12名专家参与了此次共识制定。制定声明并与专家分享以供投票。召开会议讨论第一轮未达成共识的声明，然后将其余声明再次分享以供最终投票。
该共识包括44条声明，涉及急性情况下、HF、CKD和血液透析中高钾血症的介绍与管理。36条声明在第一次投票中获得一致通过。在第二次投票中，4条声明被删除，4条声明经编辑后获得通过。
高钾血症管理缺乏标准化的定义、治疗阈值、一致的指南和实验室操作规范。本共识是针对阿拉伯海湾地区缺乏标准化治疗的情况而制定的，旨在为科威特的医疗从业者建立高钾血症管理指南，并突出未来的需求。
