Current treatment and unmet needs of hyperkalaemia in the emergency department

Rafique, Zubaid; Chouihed, Tahar; Mebazaa, Alexandre; Peacock, W. Frank

doi:10.1093/eurheartj/suy029

Cited by 32 publications

(60 citation statements)

References 95 publications

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“…Low proportions of patients in either treatment group experienced an AE of hypoglycemia, and none of these events were considered by the study investigators to be causally related to the investigational product. In a recent review article, it was recommended to lower the amount of insulin to reduce the risk of hypoglycemia and to monitor hypoglycemia for up to 6 hours after insulin use in patients with chronic kidney disease 12 . Accordingly, in thisstudy, weight‐based dosing of insulin and a monitoring schedule was used to minimize the risk of hypoglycemia 13 …”

Section: Discussionmentioning

confidence: 99%

“…Together with the lack of demonstrated efficacy of SPS, its risk–benefit profile suggests that it may not be a suitable emergency treatment of hyperkalemia 10,11 . Bicarbonate can be used in a limited population of acidotic patients and beta agonists may be effective for a short period 12 . Unfortunately, with the exception of diuretics, dialysis, and potassium binders, no treatment removes potassium from the body 12 …”

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confidence: 99%

“…Bicarbonate can be used in a limited population of acidotic patients and beta agonists may be effective for a short period 12 . Unfortunately, with the exception of diuretics, dialysis, and potassium binders, no treatment removes potassium from the body 12 …”

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confidence: 99%

“…Rebound hyperkalemia is frequent as the combination of insulin and glucose is rarely a definitive therapy, given that its mechanism of action is to shift potassium intracellularly. Hospitalization and hemodialysis are frequently required to definitively treat hyperkalemia 12,15 . Temporizing agents act to stabilize hyperkalemia until a definitive treatment, such as dialysis, can be administered 12,13,15 .…”

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confidence: 99%

“…Hospitalization and hemodialysis are frequently required to definitively treat hyperkalemia 12,15 . Temporizing agents act to stabilize hyperkalemia until a definitive treatment, such as dialysis, can be administered 12,13,15 . Furthermore, emergency treatment options for hyperkalemia are largely based on small studies, with limited evidence from randomized controlled trials to guide treatment decisions 16,17 .…”

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confidence: 99%

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Emergency Potassium Normalization Treatment Including Sodium Zirconium Cyclosilicate: A Phase II, Randomized, Double‐blind, Placebo‐controlled Study (ENERGIZE)

Peacock

Rafique

Vishnevskiy

et al. 2020

Academic Emergency Medicine

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Objectives Sodium zirconium cyclosilicate (SZC) is a novel, highly selective potassium binder currently approved in the United States and European Union for treatment of hyperkalemia. This pilot evaluation explored the efficacy of SZC with insulin and glucose as hyperkalemia treatment in the emergency department (ED). Methods This exploratory, phase II, multicenter, randomized, double‐blind, placebo‐controlled study (NCT03337477) enrolled adult ED patients with blood potassium ≥ 5.8 mmol/L. Patients were randomized 1:1 to receive SZC 10 g or placebo, up to three times during a 10‐hour period, with insulin and glucose. The primary efficacy outcome was the mean change in serum potassium (sK+) from baseline until 4 hours after start of dosing. Results Overall, 70 patients were randomized (SZC n = 33, placebo n = 37), of whom 50.0% were male. Their mean (± standard deviation [±SD]) age was 59.0 (±13.8) years and mean initial sK+ was similar between groups (SZC 6.4 mmol/L, placebo 6.5 mmol/L). The least squares mean (±SD) sK+ change from baseline to 4 hours was –0.41 (±0.11) mmol/L and –0.27 (±0.10) mmol/L with SZC and placebo, respectively (difference = –0.13 mmol/L, 95% confidence interval [CI] = –0.44 to 0.17). A greater reduction in mean (±SD) sK+ from baseline occurred with SZC compared with placebo at 2 hours: –0.72 (±0.12) versus –0.36 (±0.11) mmol/L (LSM difference = –0.35 mmol/L, 95% CI = –0.68 to –0.02), respectively. A numerically lower proportion of patients in the SZC group required additional potassium‐lowering therapy due to hyperkalemia at 0 to 4 hours versus placebo (15.6% vs. 30.6%, respectively; odds ratio = 0.40, 95% CI = 0.09 to 1.77). Comparable proportions of patients experienced adverse events in both treatment groups at 0 to 24 hours. Conclusions This pilot study suggested that SZC with insulin and glucose may provide an incremental benefit in the emergency treatment of hyperkalemia over insulin and glucose alone.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Emergency Potassium Normalization Treatment Including Sodium Zirconium Cyclosilicate: A Phase II, Randomized, Double‐blind, Placebo‐controlled Study (ENERGIZE)

Peacock

Rafique

Vishnevskiy

et al. 2020

Academic Emergency Medicine

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Renal failure and dialysis

Guzman¹,

Kitch²

2021

Emergency Medical Services

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Hyperkalemia management in the emergency department: An expert panel consensus

et al. 2021

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Hyperkalemia is a common electrolyte abnormality identified in the emergency department (ED) and potentially fatal. However, there is no consensus over the potassium threshold that warrants intervention or its treatment algorithm. Commonly used medications are at best temporizing measures, and the roles of binders are unclear in the emergent setting. As the prevalence of comorbid conditions altering potassium homeostasis rises, hyperkalemia becomes more common, and hence there is a need to standardize management. A panel was assembled to synthesize the available evidence and identify gaps in knowledge in hyperkalemia treatment in the ED. The panel was composed of 7 medical practitioners, including 5 physicians, a nurse, and a clinical pharmacist with collective expertise in the areas of emergency medicine, nephrology, and hospital medicine. This panel was sponsored by the American College of Emergency Physicians with a goal to create a consensus document for managing acute hyperkalemia. The panel evaluated the evidence on calcium for myocyte stabilization and potassium shifting and excretion. This article summarizes information on available therapies for hyperkalemia and proposes a hyperkalemia treatment algorithm for the ED practitioner based on the currently available literature and highlights diagnostic pitfalls and evidence gaps.

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Current treatment and unmet needs of hyperkalaemia in the emergency department

Cited by 32 publications

References 95 publications

Emergency Potassium Normalization Treatment Including Sodium Zirconium Cyclosilicate: A Phase II, Randomized, Double‐blind, Placebo‐controlled Study (ENERGIZE)

Emergency Potassium Normalization Treatment Including Sodium Zirconium Cyclosilicate: A Phase II, Randomized, Double‐blind, Placebo‐controlled Study (ENERGIZE)

Renal failure and dialysis

Hyperkalemia management in the emergency department: An expert panel consensus

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