Hyperkalemia

Abnormally high potassium concentration in the blood, most often due to defective renal excretion. It is characterized clinically by electrocardiographic abnormalities (elevated T waves and depressed P waves, and eventually by atrial asystole). In severe cases, weakness and flaccid paralysis may occur. (Dorland, 27th ed)

Also Known As:

Networked: 4684 relevant articles (205 outcomes, 367 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Acidosis
2.	Heart Failure
3.	Chronic Renal Insufficiency
4.	Hypertension (High Blood Pressure)
5.	Renal Insufficiency (Renal Failure)

Experts

1.	Pitt, Bertram: 48 articles (01/2022 - 04/2003)
2.	Bakris, George L: 25 articles (01/2022 - 03/2004)
3.	Rossignol, Patrick: 25 articles (01/2022 - 11/2012)
4.	Palmer, Biff F: 22 articles (01/2022 - 09/2007)
5.	Zannad, Faiez: 22 articles (01/2022 - 04/2003)
6.	Kovesdy, Csaba P: 21 articles (10/2022 - 07/2010)
7.	Weir, Matthew R: 20 articles (10/2021 - 01/2002)
8.	Solomon, Scott D: 19 articles (01/2022 - 10/2004)
9.	Agarwal, Rajiv: 17 articles (10/2022 - 05/2013)
10.	Lifton, Richard P: 16 articles (01/2019 - 01/2003)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Hyperkalemia:

1.	PotassiumIBA 09/01/2023 - " Among patients who received SZC for hyperkalemia treatment, SZC use was associated with a significant reduction of 0.812 mmol/L in serum potassium. Patients with ethnicities other than Chinese, Malay, or Indian had a nominal reduction in K+ of 0.7 mmol/L and this can be accounted for the small sample size of this sub-group. The three main ethnicities which represented more than 95% of the sample showed a significant reduction in K+ levels (all three p<0.001). This is consistent with other studies with SZC which showed efficacy across various ethnicities. Patients who received SZC for hyperkalemia treatment or prevention had a significant lowering of mortality rate. This mortality reduction may have inherent biases and confounders, due to the retrospective clinical audit study design.  Conclusions: Overall, SZC was safe and effective among the audited patients. The efficacy in the real-world setting was similar to previous trials. The novel use of SZC to manage serum potassium when HD sessions are missed, such as during traveling, warrants further investigation due to potentially significant life-saving implications." 12/22/2022 - "Following the initiation of SZC and improvement in hyperkalemia, instructions on the restriction of potassium intake were loosened according to the institutional protocol. " 01/01/2020 - "For PC + HS animals, survival to 48 h was achieved in 6/7 in the AC group and 0/4 in the SC group with an improved median survival in the AC group (48 vs. 18 h, p = 0.011) DISCUSSION: Aggressive and early hyperkalemia treatment prolongs survival while reducing kidney injury and potassium levels in a combat relevant injury model in swine." 10/01/2014 - "Average potassium level pre resin was 5.8_0.26 in group-A and 5.8±0.6 in group-B, which reduced to 4.8±0.5 in group-A and 4.3±0.53 in group-B suggesting the efficacy of both drugs for treatment of hyperkalemia in CKD patients. " 11/01/2011 - "Safety and efficacy of two potassium cocktail formulations for treatment of neonatal hyperkalemia."
2.	sodium zirconium cyclosilicateIBA 01/01/2016 - "Newer options such as sodium zirconium cyclosilicate will allow for the safe and effective treatment of hyperkalemia while maintaining patients on prescribed renin-angiotensin-aldosterone system inhibitors." 10/09/2023 - "Hyperkalemia is a serious condition among intra-abdominal transplant recipients, and the safety and efficacy of sodium zirconium cyclosilicate (SZC) for its management during the early post-transplant period are not well-established. " 01/01/2017 - "Sodium zirconium cyclosilicate for which approval is pending has also shown promise in treating both acute and chronic hyperkalemia in patients with CKD. " 02/01/2023 - "This study evaluated the impact of sodium zirconium cyclosilicate (SZC) use on HRU in outpatients with hyperkalemia. " 01/01/2023 - "DIALIZE China: A Phase IIIb, Randomized, Placebo-Controlled Study to Reduce Predialysis Hyperkalemia With Sodium Zirconium Cyclosilicate in Chinese Patients."
3.	Insulin (Novolin)FDA Link 04/01/2020 - "The objectives of this study were to evaluate the safety and efficacy of insulin dosing of less than 10 units versus 10 units in patients receiving hyperkalemia treatment. " 01/01/2022 - "Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment." 01/01/2016 - "We included any study that reported on the use of insulin in the management of hyperkalemia. " 01/01/2023 - "Evaluation of Care Outcomes of Patients Receiving Hyperkalemia Treatment With Insulin in Acute Care Tertiary Hospital Emergency Department." 01/01/2022 - "This was a single-center, retrospective study evaluating adult patients with moderate renal dysfunction who received i.v. insulin for treatment of hyperkalemia. "
4.	patiromerIBA 01/01/2022 - "Patiromer used for the treatment of CKD reduces hyperkalemia recurrence leading to improved patient care. " 01/01/2017 - "Patiromer and ZS9 have improved upon the age-old standard SPS for the treatment of hyperkalemia. " 11/12/2023 - "This study represents the first head-to-head comparison of patiromer and SZC in the setting of acute hyperkalemia. " 04/11/2023 - "Efficacy and Safety of Patiromer for Chronic Hyperkalemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." 01/01/2020 - "This is the first study showing that patiromer may have a role in the acute management of hyperkalemia; however, more rigorous studies are needed."
5.	Spironolactone (Aldactone)FDA LinkGeneric 11/01/2020 - "We estimated the incidence of hyperkalemia and AKI associated with spironolactone initiation, and used target trial emulation methods to minimize confounding by indication. " 09/01/2020 - "This study aimed to classify the most common adverse reactions associated with spironolactone in women of all ages and analyze the relative risk of hyperkalemia for different age groups. " 01/01/2018 - "The risk of hyperkalemia and worsening renal function with spironolactone and study drug adherence were also similar. " 06/01/2017 - "In spironolactone trials, hyperkalemia was documented in 17.5% and in 7.5% of patients on placebo (P=.0001). " 04/01/2015 - "Hyperkalemia risk associated with combined use of spironolactone and ACE/ARB is much stronger in real-life practice than observed in clinical trials. "
6.	Glucose (Dextrose)FDA LinkGeneric 01/01/2020 - "Assessment of dextrose 50 bolus versus dextrose 10 infusion in the management of hyperkalemia in the ED." 01/01/2014 - "Bolus administration of intravenous glucose in the treatment of hyperkalemia: a randomized controlled trial." 09/01/2007 - "Prolonged fasting may provoke hyperkalemia, which can be prevented by administration of intravenous dextrose." 11/01/1981 - "Glucose-induced hyperkalemia in diabetic subjects." 01/01/1981 - "Glucose-induced hyperkalemia in diabetic subjects."
7.	SodiumIBA 09/01/1997 - "The risk of hyperkalemia is avoided and the sodium/volume load can be eliminated by dialysis." 11/16/2021 - "Multivariate logistic regression showed that estimated glomerular filtration rate (OR=0.975, 95%CI: 0.972-0.979), diastolic blood pressure (OR=0.985, 95%CI: 0.975-0.994) and serum sodium concentration (OR=0.972, 95%CI: 0.945-1.000) were the influencing factors of hyperkalemia in DKD patients. " 01/01/2021 - "The causes of hyperkalemia post kidney transplant are multifactorial and often are drug-induced, and include decreased glomerular filtration rate, tubular dysfunction, and impaired sodium delivery in the distal nephron. " 03/01/2019 - "CAS tube analysis showed a decreased level of hyperkalemia and sodium within the reference range (consistent with point of care measurements). " 10/01/2017 - "In conclusion, while the βENaC subunit plays only a minor role in sodium balance, severe hyperkalemia results in downregulation of NCC expression and activity. "
8.	polystyrene sulfonic acid (sodium polystyrene sulfonate)FDA LinkGeneric 01/01/2015 - "Sodium polystyrene sulfonate &ndash; is it truly effective treatment for hyperkalemia?" 12/07/2015 - "This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. " 01/01/2017 - "Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients." 11/01/2016 - "To describe the safety and efficacy of sodium polystyrene sulfonate (SPS) in pediatric patients with acute hyperkalemia. " 12/07/2015 - "Sodium polystyrene sulfonate has long been prescribed for this condition, although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days. "
9.	Albuterol (Salbutamol)FDA LinkGeneric 07/01/1996 - "Since no side effects occurred besides a slight increase of heart rate in 3 patients, we conclude that short-term intravenous salbutamol infusion is an effective, rapid, safe and predictable way to treat children of any age suffering from acute hyperkalemia and therefore has become the first line treatment in our center." 07/01/2002 - "To evaluate the efficacy of inhaled albuterol for treatment of hyperkalemia in premature neonates by conducting a prospective, randomized placebo-controlled and double-blinded clinical trial. " 07/01/2002 - "Efficacy of albuterol inhalation in treatment of hyperkalemia in premature neonates." 06/01/1995 - "The aim of this study is to investigate the efficacy and safety of intravenous salbutamol in hyperkalemia. " 11/01/2023 - "This case documents rebound hyperkalemia following treatment of albuterol toxicosis in a dog. "
10.	CreatinineIBA 11/16/2023 - "We found that the patient's creatinine level was normalized, pre-existing hyperkalemia was corrected, and accordingly his general condition was improved. " 06/01/2023 - "More than half of all patients presented with nonsevere hyperkalemia (less than 6.5 mmol/L) and the mean serum creatinine was 3.6 mg/dL. " 01/01/2023 - "Laboratory data were pertinent for a serum creatinine of 4.8 mg/dL (6 months prior to presentation, serum creatinine was 1.5 mg/dL, and 1 month after discharge, it was 4.6 mg/dL), and hyperkalemia of 6.0 mmol/L. " 11/09/2021 - "DM [OR 4.22 (95% CI 1.31-13.6)] and serum creatinine [OR 1.50 (95% CI 1.24-1.81)] were predictors of hyperkalemia in multivariable analyses. " 01/01/2021 - "Hyperkalemia incidence was 7.3 and 35.1 times higher at 5.5 mEq/L (hazard ratio (HR) = 7.31, 95%confidence interval (CI) = 4.19-12.76, p < 0.001) and 6.0 mEq/L (HR = 35.11, 95%CI = 8.25-149.52, p < 0.001), respectively, than the baseline creatinine level. "

Therapies and Procedures

1.	Therapeutics 01/01/2019 - "These new therapies show promising results for the chronic management of hyperkalemia, whilst also potentially allowing for the concomitant use of RAAS inhibitors at optimal doses. " 01/01/2020 - "These binders are effective in treating hyperkalemia while facilitating RAASi therapy. " 08/01/2011 - "The results of our study demonstrated that HyperK-Cocktail is a safe and effective combination therapy for children with hyperkalemia." 01/01/2017 - "Novel therapies hold promise for reducing the risk of hyperkalemia and enhancing the tolerability of RAAS antagonists." 01/01/2014 - "If approved, ZS-9 will represent a novel, first-in-class therapy for hyperkalemia with improved capacity, selectivity, and speed for entrapping K+ when compared to currently available options."
2.	Renal Dialysis (Hemodialysis) 01/01/2018 - "The availability of acute hemodialysis in Rwanda has resulted in improved patient survival and persistent hyperkalemia predicted higher mortality." 04/01/2000 - "Acute life-threatening hyperkalemia is an indication for intermittent hemodialysis because of the higher efficacy of dialysis in the clearance of low molecular weight substances." 01/14/2022 - "This study compared the results and efficacy of different clinical procedures in preventing or treating perioperative hyperkalemia, including postoperative urgent hemodialysis (UHD). " 01/01/2022 - "These post hoc analyses of the placebo arm of the phase 3b DIALIZE study (NCT03303521) explored the course of hyperkalemia in hemodialysis patients receiving placebo. " 01/01/2022 - "The prevalence of predialysis hyperkalemia and associated characteristics among hemodialysis patients: The RE-UTILIZE study."
3.	Emergency Treatment 07/01/2021 - " opinion: The emergency treatment of hyperkalemia is not supported by high-quality evidence and clinical trials did not report drug effects on clinical outcomes. " 11/01/2016 - "Existing emergency treatments for severe hyperkalemia are not supported by a compelling body of evidence, and they are used inconsistently across institutions, with potentially significant associated side effects. " 11/01/2016 - "The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT) aimed to evaluate the current knowledge pertaining to the emergency treatment of hyperkalemia. " 01/01/1981 - "The emergency treatment of hyperkalemia." 03/01/2016 - "ZS-9 shows promise in the acute treatment of hyperkalemia and may make it possible to avoid or postpone the most effective therapy, emergency hemodialysis. "
4.	Intravenous Administration 07/01/1987 - "In ureter ligated dogs intravenous administration of KCl stimulates both insulin secretion and activity of a kaluresis independent K homeostatic mechanism (K transfer capacity) that retards the development of hyperkalemia by transferring K to intracellular fluid. " 11/01/2003 - "Hypokalemia is treated best by oral administration of feed-grade KCl; hyperkalemia is treated best by intravenous administration of 8.0% NaHCO3 or HS. " 10/01/2010 - "Hypokalemia often reflects dietary K+ deficiency, alkalosis, renal or gastrointestinal loss of K+. Hypokalemia is more likely to cause arrhythmia than hyperkalemia and can be treated by oral or intravenous administration of K+ under frequent control of electrocardiogram and plasma K+. Because of their size and high contents of K+, Na+,K+ pumps and K+ channels, the skeletal muscles play a central role in the acute, from min-to-min ongoing regulation of plasma K+. This is decisive for the maintenance of muscle contractility and heart function." 01/01/2022 - "Among MHD patients with acute hyperkalemia, SZC had similar potassium-lowering efficacy with IG intravenous administration at 2 h and superior on convenience and side-effects." 04/01/2019 - "Stringent regulations have been established for the intravenous administration of potassium to avoid hyperkalemia in the clinic. "
5.	Resuscitation 11/01/2019 - "In our pilot study of traumatic PEA in a swine model, a shorter period of nonintervention resulted in increased survival, improved hemodynamics during resuscitation, decreased hyperkalemia, and less incidence of conversion to VF arrest." 12/01/2022 - "Intravenous (IV) fluid resuscitation and medical management of hyperkalemia were initiated, along with BiPAP for respiratory distress. " 10/01/2021 - "Hyperkalemia and presenting cardiac rhythm correlate with survival although they are not reasons to end resuscitation. " 06/01/2018 - "With standard resuscitation and anti-hyperkalemia treatment, return of spontaneous circulation (ROSC) was achieved within 10 minutes of compressions. " 06/01/2015 - "A standardized approach for pediatric life-threatening hyperkalemia is recommended to improve resuscitation quality."