Abstract:Hyperkalemia (serum K 1 .5.0 mmol/L) is commonly observed among patients receiving maintenance hemodialysis and associated with increased risk of cardiac arrhythmias. Current international guidelines may not reflect the latest evidence on managing hyperkalemia in patients undergoing hemodialysis, and there is a lack of high-quality published studies in this area. This consensus guideline aims to provide recommendations in relation to clinical practice. Available published evidence was evaluated through a syste… Show more
“…There is expert recommendation to use SZC and Patiromer to treat acute hyperkalaemia in specific scenarios, for example, when haemodialysis is not available or cannot be done. 21 NICE assumed these products were beneficial based on data looking at patients requiring long term hyperkalaemia treatment in renal impairment rather than in the treatment of acute hyperkalaemia. Their effectiveness in acute hyperkalaemia is based on small scale early phase 22 study or uncontrolled evidence.…”
What is Known and Objective: Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS).Methods: A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics.Based on the results a naïve cost comparison between the two drugs was made.Results and Discussion: CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input.What is New and Conclusion: Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies.
“…There is expert recommendation to use SZC and Patiromer to treat acute hyperkalaemia in specific scenarios, for example, when haemodialysis is not available or cannot be done. 21 NICE assumed these products were beneficial based on data looking at patients requiring long term hyperkalaemia treatment in renal impairment rather than in the treatment of acute hyperkalaemia. Their effectiveness in acute hyperkalaemia is based on small scale early phase 22 study or uncontrolled evidence.…”
What is Known and Objective: Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS).Methods: A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics.Based on the results a naïve cost comparison between the two drugs was made.Results and Discussion: CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input.What is New and Conclusion: Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies.
“…More frequent monitoring should be considered in patients with multiple risk factors, for example presence of mild hyperkalaemia at baseline, 11 concomitant use of medications that can increase potassium, 30,31 and treatment with intermittent haemodialysis 32 …”
Section: Prevention Of Hyperkalaemia For At‐risk Individualsmentioning
confidence: 99%
“…More frequent monitoring should be considered in patients with multiple risk factors, for example presence of mild hyperkalaemia at baseline, 11 concomitant use of medications that can increase potassium, 30,31 and treatment with intermittent haemodialysis. 32 The requirements and schedules of hyperkalaemia monitoring in patients receiving RAAS inhibitors have been proposed in various international guidelines and expert consensuses. [27][28][29][30][31][32] Serum potassium measurement within 1-2 weeks of starting or dose-escalating RAAS inhibitors is generally recommended for patients with CKD, DM or heart failure.…”
Hyperkalaemia is an electrolyte imbalance that impairs muscle function and myocardial excitability, and can potentially lead to fatal arrhythmias and sudden cardiac death. The prevalence of hyperkalaemia is estimated to be 6%–7% worldwide and 7%–10% in Asia. Hyperkalaemia frequently affects patients with chronic kidney disease, heart failure, and diabetes mellitus, particularly those receiving treatment with renin‐angiotensin‐aldosterone system (RAAS) inhibitors. Both hyperkalaemia and interruption of RAAS inhibitor therapy are associated with increased risks for cardiovascular events, hospitalisations, and death, highlighting a clinical dilemma in high‐risk patients. Conventional potassium‐binding resins are widely used for the treatment of hyperkalaemia; however, caveats such as the unpalatable taste and the risk of gastrointestinal side effects limit their chronic use. Recent evidence suggests that, with a rapid onset of action and improved gastrointestinal tolerability, novel oral potassium binders (e.g., patiromer and sodium zirconium cyclosilicate) are alternative treatment options for both acute and chronic hyperkalaemia. To optimise the care for patients with hyperkalaemia in the Asia–Pacific region, a multidisciplinary expert panel was convened to review published literature, share clinical experiences, and ultimately formulate 25 consensus statements, covering three clinical areas: (i) risk factors of hyperkalaemia and risk stratification in susceptible patients; (ii) prevention of hyperkalaemia for at‐risk individuals; and (iii) correction of hyperkalaemia for at‐risk individuals with cardiorenal disease. These statements were expected to serve as useful guidance in the management of hyperkalaemia for health care providers in the region.image
“…The panel recommends an upper limit of normal of 5.0 mEq/L considering the potassium-dependent increased mortality risk 3 and recent consensus statements of medical societies. 4,8,11 The severity of hyperkalemia shall be classified as mild (>5.0 to <5.5 mEq/L), moderate (5.5-6.0 mEq/L), and severe (>6.0 mEq/L). Potassium levels between current local upper limits of normal and 5.5 mEq/L shall be considered as mild hyperkalemia.…”
Section: Definition Of Hyperkalemia In the Gcc Regionmentioning
Hyperkalemia is a frequent complication in patients with chronic kidney disease (CKD) or heart failure (HF) and associated with neuromuscular manifestations, changes in the electrocardiogram, and increased risk of mortality. While data on the prevalence and management of hyperkalemia in the gulf region are scarce, risk factors such as preference for potassium-rich foods (e.g., dates and dried fruits/vegetables), periods of intense fasting (e.g., Ramadan), and diabetes (an ancestor of CKD and HF) are common.Therefore, a panel of nephrologists and cardiologists from countries of the Gulf Cooperation Council (GCC) convened to collate and review available data on the prevalence, regional drivers, and current practice in the management of hyperkalemia in the region.Eventually, this review provides consensus recommendations on a balanced utilization of dietary and pharmacological options including new potassium binders for achieving and sustainably maintaining desirable serum potassium levels in countries of the GCC region. Alignment with regional habits and practice was a key aspect to facilitate the uptake of the recommendations into physicians' practice and patients' lives.
K E Y W O R D Schronic kidney disease, heart failure, hyperkalemia, potassium binding
INTRODUCTIONHyperkalemia is a frequent complication in chronic kidney disease (CKD) and heart failure (HF) patients, particularly those on reninangiotensin-aldosterone inhibitor (RAASi) therapy. 1,2 It is associ-All authors contributed equally to the preparation of this manuscript.
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