Fujimaru Takuya, Hirose Kazuhito, Yazawa Masahiko, Nagahama Masahiko, Kovesdy Csaba P
Department of Nephrology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Department of General Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan.
Clin Exp Nephrol. 2025 Jul 24. doi: 10.1007/s10157-025-02728-2.
This article is part of a review series on water and electrolyte disorders, based on the annual "Electrolyte Winter Seminar" for early-career nephrologists in Japan. The seminar features interactive case-based discussions, some of which are included as self-assessment questions. The fifth installment addresses the management of hyperkalemia. Hyperkalemia frequently occurs in patients with chronic kidney disease (CKD) and can become life-threatening when severe, necessitating prompt treatment regardless of its underlying cause. Renin-angiotensin system inhibitors (RASi) are a recognized risk factor for hyperkalemia in CKD; however, discontinuing RASi in response to elevated potassium levels may adversely affect patient outcomes. Although there are no formal criteria distinguishing acute from chronic hyperkalemia, symptoms presentation and potassium levels offer a practical guide for clinical management. This review covers standard treatment strategies for severe (symptomatic or acute) hyperkalemia in emergency and inpatient settings and discusses how to manage mild-to-moderate (asymptomatic or chronic) cases in CKD patients while continuing RASi therapy.
本文是关于水和电解质紊乱的系列综述文章的一部分，该系列基于日本为初职肾病学家举办的年度“电解质冬季研讨会”。该研讨会以基于病例的互动讨论为特色，其中一些讨论内容被纳入了自我评估问题。第五部分论述高钾血症的管理。高钾血症在慢性肾脏病（CKD）患者中经常发生，严重时可危及生命，无论其潜在病因如何都需要及时治疗。肾素 - 血管紧张素系统抑制剂（RASi）是CKD患者发生高钾血症的公认危险因素；然而，因血钾水平升高而停用RASi可能会对患者的治疗结果产生不利影响。虽然目前尚无区分急性高钾血症和慢性高钾血症的正式标准，但症状表现和血钾水平为临床管理提供了实用指南。本综述涵盖了急诊和住院环境中重度（有症状或急性）高钾血症的标准治疗策略，并讨论了在继续使用RASi治疗的同时，如何管理CKD患者的轻度至中度（无症状或慢性）病例。
