Management of Hyperkalemia: An Update for the Internist

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• 作者：Csaba P. Kovesdy ; MD ; ^{csaba.kovesdy@va.gov" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Chronic kidney disease ; Glomerular filtration rate ; Hyperkalemia ; Mortality ; Renin-angiotensin-aldosterone system ; Serum potassium
• 刊名：The American Journal of Medicine
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：128
• 期：12
• 页码：1281-1287
• 全文大小：458 K

文摘

Hyperkalemia is a clinically important electrolyte abnormality that occurs most commonly in patients with chronic kidney disease. Due to its propensity to induce electrophysiological disturbances, severe hyperkalemia is considered a medical emergency. The management of acute and chronic hyperkalemia can be achieved through the implementation of various interventions, one of which is the elimination of medications that can raise serum potassium levels. Because many such medications (especially inhibitors of the renin-angiotensin aldosterone system) have shown beneficial effects in patients with cardiovascular and renal disease, their discontinuation for reasons of hyperkalemia represent an undesirable clinical compromise. The emergence of 2 new potassium-binding medications for acute and chronic therapy of hyperkalemia may soon allow the continued use of medications such as renin-angiotensin-aldosterone system inhibitors even in patients who are prone to hyperkalemia. This review article provides an overview of the physiology and the pathophysiology of potassium metabolism and hyperkalemia, the epidemiology of hyperkalemia, and its acute and chronic management. We discuss in detail emerging data about new potassium-lowering therapies, and their potential future role in clinical practice.