Emergency interventions for hyperkalaemia

Mahoney, Brian A; Smith, Willard Ad; Lo, D; Tsoi, Kim; Tonelli, Marcello; Clase, Catherine M.

doi:10.1002/14651858.cd003235.pub2

Cited by 142 publications

(145 citation statements)

References 29 publications

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“…[1][2][3][4][5][6] Sodium polystyrene sulfonate (SPS) is a potassiumbinding resin commonly used to treat mild acute or chronic hyperkalemia by increasing the excretion of potassium in stool. 7 SPS is predominantly used for mild hyperkalemia (defined as serum potassium between 5 and 6 mmol/L), where the risk of complications is low.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Sodium Polystyrene Sulfonate for Short-Term Treatment of Hyperkalemia

Batterink

Lin

Au-Yeung

et al. 2015

CJHP

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Section: Introductionmentioning

confidence: 99%

Effectiveness of Sodium Polystyrene Sulfonate for Short-Term Treatment of Hyperkalemia

Batterink

Lin

Au-Yeung

et al. 2015

CJHP

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“…A Cochrane review found no trial evidence of major outcome benefit for any emergency hyperkalaemia therapy with the best efficacy when medical (as opposed to dialysis) potassium lowering is required was for beta agonists and intravenous insulin-and-glucose. [7] The safety of neither therapy has been established specifically in the HF population. In view of their risks beta agonists are usually avoided in HF.…”

Section: Hyperkalaemiamentioning

confidence: 99%

The Management of Co-Morbidities in Patients with Heart Failure – Potassium Balance

Jankowska¹

2017

ICFJ

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Both hypokalaemia and hyperkalaemia are common in HF patients. They are each associated both with HF and with the many drugs used for HF. They are important as they both can aggravate ventricular arrhythmias, both can cause symptoms in HF patients and in the case of hyperkalaemia in particular, are a common reason not to prescribe or reduce the dose of or even cease use of effective medication with life- prolonging benefits in HFrEF, including ACEI’s and MRA’s. Treatment optiosn for bioth hypokalaemia and hyperkalaemia are discussed including the emerging evidence that agents such as patiromer may be safe and effective agents to be used long-term in high-risk patients with HF to allow them to take doses of RAAS inhibitors in particular which they otherwise may not be able to take. This might allow them to continue to receive the mortality morbidity benefits these treatments confer.

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“…These considerations support instituting acute therapy for patients with moderate-to-severe hyperkalemia according to the criteria specified above, 33 although minimal evidence from clinical trials is available on the acute treatment of hyperkalemia. 36 Some data suggest that ZS-9 37 and patiromer 38 may have an onset of action sufficient to allow the use of these agents in the acute setting. More data are needed to fully understand these findings and determine whether the observation of an early effect (1-4 hours with ZS-9) was because of shifting potassium (ie, because of postprandial insulin release in patients who were fasting before ZS-9 was administered or alkalization from the conversion of the sodium component of ZS-9 to bicarbonate), or to true potassium removal.…”

Section: Practical Clinical Management Of Hyperkalemia Acute Hyperkalmentioning

confidence: 99%

New Potassium Binders for the Treatment of Hyperkalemia

Pitt

Bakris

2015

Hypertension

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H yperkalemia is a clinical problem with potential mechanisms ranging from increased cellular potassium release (eg, pseudohyperkalemia, metabolic acidosis) to reduced potassium excretion (eg, reduced responsiveness to aldosterone, reduced aldosterone secretion, reduced distal sodium, and water delivery).1,2 Patients with chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <45 mL/min per 1.73 m 2 , are at increased risk of hyperkalemia, resulting from ≥1 of these mechanisms.3 Renin-angiotensinaldosterone system inhibitors (RAASis) are recommended by guidelines for lowering blood pressure, slowing CKD progression in patients with CKD, 4,5 and reducing cardiovascular mortality and heart failure hospitalizations in patients with heart failure and a reduced ejection fraction, 6,7 but these drugs compound the hyperkalemia risk. 1,[8][9][10] The risk is magnified when the drugs are used in combination (eg, aliskiren in combination with ACE inhibitors or angiotensin receptor blockers; 8,11 mineralocorticoid receptor antagonists in combination with ACE inhibitors or angiotensin receptor blockers). Moreover, the risk for hyperkalemia is magnified in diseases, such as diabetes mellitus and heart failure. 4,5,12,13 The occurrence or fear of inducing hyperkalemia has led to premature discontinuation, suboptimal dosing, and often failure to use an RAASi, thereby exposing patients to increased cardiovascular risk.Current treatment approaches for chronic hyperkalemia are limited. Options for the management of hyperkalemia include discontinuation or reduced doses of RAASi, administration of loop diuretics, dietary potassium restriction, or sodium polystyrene sulfonate.14 None of these approaches are optimal because they require withholding life-saving or kidney preserving therapy (ie, RAASi), have a low rate of patient adherence (eg, dietary restriction), or have an unfavorable adverse effect profile and low tolerability (ie, sodium polystyrene sulfonate). 15 New agents to treat hyperkalemia are in the late stages of development. Clinical trial data suggest that these new agents effectively lower serum potassium and are well tolerated. [16][17][18][19][20] Therefore, these agents offer promising advantages over existing management options. It is possible that these agents might also facilitate maintenance of RAASi across the broad spectrum of patients with RAASi intolerance because of hyperkalemia (eg, CKD and heart failure), 18 and testing this hypothesis in larger clinical trials is warranted. This article reviews the clinical problem of hyperkalemia and identifies predictors of hyperkalemia in patients with hypertension, CKD, diabetes mellitus, and heart failure. It also presents recent clinical trial evidence of the efficacy and safety of new treatments for hyperkalemia, and it discusses how these agents may be used clinically, if approved. Overview of HyperkalemiaThe rate of hyperkalemia is low in uncomplicated hypertension patients treated with RAASi, 21 but it rises in the setting o...

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Emergency interventions for hyperkalaemia

Abstract: Analysis 23.1. Comparison 23 IV bicarbonate plus IV salbutamol versus IV insulin-glucose, Outcome 1 Serum potassium. Analysis 24.1. Comparison 24 IV insulin-glucose plus IV bicarbonate plus IV salbutamol versus IV insulin-glucose, Outcome 1 Serum potassium.

Cited by 142 publications

References 29 publications

Effectiveness of Sodium Polystyrene Sulfonate for Short-Term Treatment of Hyperkalemia

Effectiveness of Sodium Polystyrene Sulfonate for Short-Term Treatment of Hyperkalemia

The Management of Co-Morbidities in Patients with Heart Failure – Potassium Balance

New Potassium Binders for the Treatment of Hyperkalemia

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