Epidemiology of hyperkalemia in chronic kidney disease

Vega, Lara Belmar; Galabia, Emilio Rodrigo; Silva, Jairo Bada da; González, M.; Fresnedo, Gema Fernández; Haces, Celestino Piñera; Fontanet, Rosa Palomar; Millán, Juan Carlos Ruíz San; Francisco, A.L.M. de

doi:10.1016/j.nefroe.2018.11.014

Cited by 31 publications

(30 citation statements)

References 40 publications

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“…Studies in patients with CKD have shown a remarkable frequency in hyperkalemia in advanced CKD stages, hyporreninemic hypoaldosteronic diabetic patients, renal transplantation (RT), and patients with RAAS inhibition (4,6). Available information shows prevalence percentages ranging from 5 to 20% depending on the stage of CKD (13). The burden of hyperkalemia is remarkable not only in terms of prevalence, but also in terms of patient survival even for serum potassium levels only moderately increased (14,15).…”

Section: Hyperkalemia In Patients With Ckd Non-dialysismentioning

confidence: 99%

Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

2021

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Hyperkalemia is one of the main electrolyte disorders in patients with chronic kidney disease (CKD). The prevalence of hyperkalemia increases as the Glomerular Filtration Rate (GFR) declines. Although chronic hyperkalemia is not a medical emergency, it can have negative consequences for the adequate cardio-renal management in the medium and long term. Hyperkalemia is common in patients on renin-angiotensin-aldosterone system inhibitors (RAASi) or Mineralocorticoid Receptor Antagonists (MRAs) and can affect treatment optimization for hypertension, diabetes mellitus, heart failure (HF), and CKD. Mortality rates are higher with suboptimal dosing among patients with CKD, diabetes or HF compared with full RAASi dosing, and are the highest among patients who discontinue RAASis. The treatment of chronic hyperkalemia is still challenging. Therefore, in the real world, discontinuation or reduction of RAASi therapy may lead to adverse cardiorenal outcomes, and current guidelines differ with regard to recommendations on RAASi therapy to enhance cardio and reno-protective effects. Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin over 50 years ago. Nowadays, two new potassium binders, Patiromer Sorbitex Calcium, and Sodium Zirconium Cyclosilicate (SZC) already approved by FDA and by the European Medicines Agency, have demonstrated their clinical efficacy in reducing serum potassium with a good safety profile. The use of the newer potassium binders may allow continuing and optimizing RAASi therapy in patients with hyperkalemia keeping the cardio-renal protective effect in patients with CKD and cardiovascular disease. However, further research is needed to address some questions related to potassium disorders (definition of chronic hyperkalemia, monitoring strategies, prediction score for hyperkalemia or length for treatment).

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Section: Hyperkalemia In Patients With Ckd Non-dialysismentioning

confidence: 99%

Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

2021

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“… 1 , 2 In patients with advanced chronic kidney disease (CKD), the progressive decline in kidney function contributes to the development of hyperkalemia, the definition of which varies between institutional guidelines and clinical studies and is generally considered to be a serum potassium level > 5.0 or > 5.5 mEq/L. 1 , 3 , 4 Hyperkalemia risk increases as CKD progresses, 3 with a reported prevalence of up to 10% in those with CKD without kidney replacement therapy, 16% in patients with kidney failure receiving hemodialysis, and 11% in those receiving continuous ambulatory peritoneal dialysis. 4 …”

Section: Introductionmentioning

confidence: 99%

“… 1 , 3 , 4 Hyperkalemia risk increases as CKD progresses, 3 with a reported prevalence of up to 10% in those with CKD without kidney replacement therapy, 16% in patients with kidney failure receiving hemodialysis, and 11% in those receiving continuous ambulatory peritoneal dialysis. 4 …”

Section: Introductionmentioning

confidence: 99%

Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet

2020

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In patients with advanced-stage chronic kidney disease (CKD), progressive kidney function decline leads to increased risk for hyperkalemia (serum potassium > 5.0 or >5.5 mEq/L). Medications such as renin-angiotensin-aldosterone system inhibitors pose an additional hyperkalemia risk, especially in patients with CKD. When hyperkalemia develops, clinicians often recommend a diet that is lower in potassium content. This review discusses the barriers to adherence to a low-potassium diet and the impact of dietary restrictions on adverse clinical outcomes. Accumulating evidence indicates that a diet that incorporates potassium-rich foods has multiple health benefits, which may also be attributable to the other vitamin, mineral, and fiber content of potassium-rich foods. These benefits include blood pressure reductions and reduced risks for cardiovascular disease and stroke. High-potassium foods may also prevent CKD progression and reduce mortality risk in patients with CKD. Adjunctive treatment with the newer potassium-binding agents, patiromer and sodium zirconium cyclosilicate, may allow for optimal renin-angiotensin-aldosterone system inhibitor therapy in patients with CKD and hyperkalemia, potentially making it possible for patients with CKD and hyperkalemia to liberalize their diet. This may allow them the health benefits of a high-potassium diet without the increased risk for hyperkalemia, although further studies are needed.

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“…The estimated prevalence of hyperkalemia in patients with chronic kidney disease (CKD) without renal replacement therapy is 9.6%. 1 Those requiring renal replacement therapy in the form of hemodialysis and continuous ambulatory peritoneal dialysis have a prevalence of 16.5% and 10.6%, respectively. 1 An increase in extracellular potassium lowers the cardiac membrane potential and predisposes the heart to fatal arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

“… 1 Those requiring renal replacement therapy in the form of hemodialysis and continuous ambulatory peritoneal dialysis have a prevalence of 16.5% and 10.6%, respectively. 1 An increase in extracellular potassium lowers the cardiac membrane potential and predisposes the heart to fatal arrhythmias. 2 Observational data have demonstrated a U-shaped association between serum potassium and mortality.…”

Section: Introductionmentioning

confidence: 99%

Polysulfonate Resins in Hyperkalemia: A Systematic Review

Wong

Zhang

Norman³

et al. 2020

Can J Kidney Health Dis

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Background: Hyperkalemia is a potentially life-threatening electrolyte abnormality defined as a serum potassium above the lab reference range (usually >5.0-5.5 mEq/L). Polystyrene resins, including sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS), have long been used to treat hyperkalemia. Sodium polystyrene sulfonate/calcium polystyrene sulfonate act by exchanging a cation for potassium within the intestinal lumen. While SPS and CPS have been available since the 1960s, there are rising concerns about the validity of the data supporting its use and about serious adverse gastrointestinal effects. Objective: The objective of this systematic review was to quantify the efficacy and safety of polystyrene sulfonate resins (SPS/CPS) in the treatment of adults with hyperkalemia. This review focuses on the randomized control trial (RCT), interventional non-RCT, and observational data available on SPS/CPS use. Design: Systematic review. Setting: Any country of origin. Both inpatient and outpatient settings. Patients: Adults with hyperkalemia treated with polystyrene sulfonate resins. Measurements: The primary outcome was change in serum potassium. The secondary outcomes included adverse effects of SPS/CPS and prevention of recurrent hyperkalemia. Methods: We conducted a systematic review using Cochrane Library, EMBASE (1947-2019), and Medline (1946-2019) databases. Literature reviews, systematic reviews, case studies, case series, and editorial pieces were excluded. Included studies were assessed for risk of bias. Results: Four RCTs, 21 observational studies, and 5 quasi-experimental trials were included. A total of 212 351 patients were included. Two thousand and fifty-eight patients were studied for the primary outcome and 210 293 patients were studied for the secondary outcomes. Study designs were heterogeneous and not amenable to meta-analysis. Most studies included nonhemodialysis outpatients older than 65 years. Of the included studies, 22/25 (88%) demonstrated a reduction of serum potassium >0.5 mEq/L over the study period. The magnitude of reduction in serum potassium of potassium resin compared with placebo or matched controls in the 3 low-risk studies identified was 0.14 to 1.04 mEq/L. However, each study used different dosing regimens. Ten of 22 studies reported the effects of polystyrene resins on serum potassium within 24 hours. A few high-quality observational studies suggest an increased risk of serious adverse gastrointestinal events with a relative risk of 2.10 and a hazard ratio of 1.25 to 1.94; however, the absolute risk remains low. The incidence of adverse gastrointestinal events is 16 to 23 events per 1000 person-years. Limitations: We acknowledge several limitations in this study. Case studies and case series were excluded from the search results. Large case series may have been excluded despite having comparable sample sizes to studies included due to lack of a comparator and calculated estimates. Due to the heterogeneity of the studies, the data were unable to be meta-analyzed and as such the potassium-lowering effect of polystyrene sulfonate resins remains founded on small studies with potential confounders. Conclusions: This systematic review demonstrates a continued lack of high-quality evidence for the use of SPS/CPS in hyperkalemia. Studies investigated highly variable timelines and the most robust evidence for SPS/CPS use is in chronic hyperkalemia. While the absence of high-quality evidence does not exclude the possibility of benefit, prescribers must understand that the use of SPS/CPS in acute hyperkalemia is not supported by high-quality evidence. Trial registration: The protocol for this systematic review was not registered.

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Epidemiology of hyperkalemia in chronic kidney disease

Cited by 31 publications

References 40 publications

Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet

Polysulfonate Resins in Hyperkalemia: A Systematic Review

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