Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future

Rossignol, Patrick; Legrand, Matthieu; Kosiborod, Mikhail; Hollenberg, Steven M.; Peacock, W. Frank; Emmett, Michael; Epstein, Murray; Kövesdy, Csaba P.; Yilmaz, Mehmet Birhan; Stough, Wendy Gattis; Gayat, Étienne; Pitt, Bertram; Zannad, Faı̈ez; Mebazaa, Alexandre

doi:10.1016/j.phrs.2016.09.039

Cited by 97 publications

(122 citation statements)

References 42 publications

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“…In the current study, the risk of arrhythmia was elevated in patients with serum K + levels >5.5 mmol/L, consistent with the findings of previous research 13, 21, 25 . However, arrhythmia alone cannot explain the association between elevated serum K + levels and adverse outcomes, as the relationship remained to be significant in patients without prominent hyperkalaemia, even after excluding patients with arrhythmia events.…”

Section: Discussionsupporting

confidence: 93%

“…The presence of hyperkalaemia is a well-known, strong risk factor for critical arrhythmia 13, 15, 24, 25 . In the current study, the risk of arrhythmia was elevated in patients with serum K + levels >5.5 mmol/L, consistent with the findings of previous research 13, 21, 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, hyperkalaemia is associated with worse prognosis and can induce critical arrhythmia 8–12 . Hence, management of this electrolyte imbalance has been suggested in clinical guidelines and is widely practised 13–15 .…”

Section: Introductionmentioning

confidence: 99%

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Elevated baseline potassium level within reference range is associated with worse clinical outcomes in hospitalised patients

Park

Baek

Lee

et al. 2017

Sci Rep

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The clinical significance of elevated baseline serum potassium (K+) levels in hospitalised patients is rarely described. Hence, we performed a retrospective study assessing the significance of elevated K+ levels in a one-year admission cohort. Adult patients without hypokalaemia or end-stage renal disease were included. Adverse outcomes were all-cause mortality, hospital-acquired acute kidney injury, and events of arrhythmia. In total, 17,777 patients were included in the study cohort, and a significant difference (P < 0.001) was observed in mortality according to baseline serum K+ levels. The adjusted hazard ratios (HRs) and associated 95% confidence intervals (CIs) of all-cause mortality for K+ levels above the reference range of 3.6–4.0 mmol/L were as follows: 4.1–4.5 mmol/L, adjusted HR 1.075 (95% CI 0.981–1.180); 4.6–5.0 mmol/L, adjusted HR 1.261 (1.105–1.439); 5.1–5.5 mmol/L, adjusted HR 1.310 (1.009–1.700); >5.5 mmol/L, adjusted HR 2.119 (1.532–2.930). Moreover, the risks of in-hospital acute kidney injury and arrhythmia were higher in patients with serum K+ levels above 4.0 mmol/L and 5.5 mmol/L, respectively. In conclusion, increased serum K+ levels, including mild elevations may be related to worse prognosis. Close monitoring and prompt correction of underlying causes or hyperkalaemia itself is warranted for admitted patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Elevated baseline potassium level within reference range is associated with worse clinical outcomes in hospitalised patients

Park

Baek

Lee

et al. 2017

Sci Rep

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“…Hyperkalaemia is associated with an increased risk of cardiac arrhythmias and mortality. 1,2 Hyperkalaemia risk is increased with older age and among patients with chronic kidney disease (CKD), heart failure (HF), and diabetes, as well as those receiving renin-angiotensin-aldosterone system inhibitors (RAASis). 1,3 Options for outpatient management of hyperkalaemia were previously limited to non-specific cation-binding organic polymers, such as sodium polystyrene sulfonate and patiromer, which bind potassium (K + ) in exchange for sodium and calcium ions, respectively.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of sodium zirconium cyclosilicate for hyperkalaemia: the randomized, placebo‐controlled HARMONIZE‐Global study

et al. 2020

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Aims Sodium zirconium cyclosilicate (SZC, formerly ZS‐9) is a selective K+ binder to treat adults with hyperkalaemia. HARMONIZE‐Global examined the efficacy and safety of SZC among outpatients with hyperkalaemia from diverse geographic and ethnic origins. Methods and results This phase 3, randomized, double‐blind, placebo‐controlled study recruited outpatients with serum K+ ≥5.1 mmol/L (measured by point‐of‐care i‐STAT device) at 45 sites in Japan, Russia, South Korea, and Taiwan. Following open‐label treatment with thrice‐daily SZC 10 g during a 48 h correction phase (CP), patients achieving normokalaemia (K+ 3.5–5.0 mmol/L) were randomized 2:2:1 to once‐daily SZC 5 g, SZC 10 g, or placebo during a 28 day maintenance phase (MP). The primary endpoint was mean central‐laboratory K+ level during days 8–29 of the MP. Of 267 patients in the CP, 248 (92.9%) entered the MP. During the CP, mean central‐laboratory K+ was reduced by 1.28 mmol/L at 48 h vs. baseline (P < 0.001). During the MP (days 8–29), SZC 5 and 10 g once‐daily significantly lowered mean central‐laboratory K+ by 9.6% and 17.7%, respectively, vs. placebo (P < 0.001 for both). More patients had normokalaemia (central‐laboratory K+ 3.5–5.0 mmol/L at day 29) with SZC 5 (58.6%) and 10 g (77.3%) vs. placebo (24.0%), with the greatest number of normokalaemic days in the 10‐g group. The most common adverse events with SZC were mild or moderate constipation and oedema. Conclusions Normokalaemia achieved during the CP was maintained over 28 days with SZC treatment among outpatients with hyperkalaemia.

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“…Normalisation of S‐K + can be accomplished by reducing K + intake from external sources, shifting K + from the blood into the cells, increasing K + removal from the body or a combination thereof. Specific guidelines for the emergency management of life‐threatening hyperkalaemia (ie, with electrocardiogram [ECG] changes) have been published . In the emergency setting, interventions aim to protect patients from immediate dangers of elevated S‐K + (such as cardiac arrest) by redistributing K + ions from the bloodstream into the cells .…”

Section: Introductionmentioning

confidence: 99%

Evidence in support of hyperkalaemia management strategies: A systematic literature review

et al. 2018

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Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future

Cited by 97 publications

References 42 publications

Elevated baseline potassium level within reference range is associated with worse clinical outcomes in hospitalised patients

Elevated baseline potassium level within reference range is associated with worse clinical outcomes in hospitalised patients

Efficacy and safety of sodium zirconium cyclosilicate for hyperkalaemia: the randomized, placebo‐controlled HARMONIZE‐Global study

Evidence in support of hyperkalaemia management strategies: A systematic literature review

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