New Hyperkalemia Guidelines Help Patients with CKD Manage, Treat High Potassium

LaVarne Burton

Credit: American Kidney Fund

New patient-focused guidelines from the American Kidney Fund (AKF) are helping individuals with chronic kidney disease (CKD) manage and treat hyperkalemia.¹

Released on July 11, 2024, the guidelines were developed with support from AstraZeneca and provide patients with guidance on how to discuss high potassium with their health care provider, understand their potassium level, recognize symptoms of high potassium, and adhere to their treatment plan.^1,2

"Managing hyperkalemia can be overwhelming and stressful," said LaVarne Burton, President and CEO of AKF, in a press release.¹ "These guidelines will help people with hyperkalemia understand the importance of keeping potassium at a healthy level and will give them the knowledge they need to take an active role in managing their health care."

Elevated potassium in the blood, known as hyperkalemia, is unpredictable and can be life-threatening, often present without warning signs or with nonspecific symptoms. According to the National Kidney Foundation, hyperkalemia frequency may be as high as 40-50% in people with CKD compared to 2-3% in the general population. Additionally, more than half of predialysis CKD patients develop hyperkalemia.³

To develop the guidelines, AKF conducted focus groups with patients and professionals and worked with medical experts on the evidence-based, health-literate content. Focus group participants included people with hyperkalemia and people in the general kidney patient population, all of whom were asked to share their awareness of hyperkalemia and their knowledge of how to manage it.¹

The guideline begins with an outline of steps for patients to take if they are at risk of high potassium, emphasizing the importance of monitoring potassium levels through blood tests and working with a health care team to conduct routine lab work and establish a treatment plan. It then outlines 4 steps for patients to consider taking:

• Talk to your provider about high potassium
• Know your potassium numbers
• Understand why it is important to keep potassium at a healthy level
• If you have high potassium, your provider will create a customized treatment plan

Discuss Potassium with Your Provider

The first step recommended by the guidelines for managing and treating hyperkalemia is discussing high potassium with a health care provider. Several example questions are listed, pertaining to topics ranging from what your potassium level is to what may have caused it and potential treatment approaches to consider moving forward:

• What is my potassium level? What should my potassium level be?
• Why do I have high potassium? What caused it?
• What changes can I make to manage high potassium? Do I need to take any medicines to treat high potassium?
• What should I do if I have symptoms of high potassium?

Be Aware of Your Potassium Level

The guidelines go on to describe how providers will monitor potassium levels with routine electrolyte panels, also providing patients with tips regarding how to understand their test results. According to the AKF patient resource, healthy potassium levels typically range between 3.5-5.0 mmol/L, while potassium levels are considered to be high if they exceed 5.0 mmol/L. Mild to moderate high potassium is 5.0-5.9 mmol/L, and 6.0-6.4 mmol/L constitutes severe high potassium.²

For patients with potassium exceeding 5.0 mmol/L, the guidelines recommend discussing a treatment plan with a health care provider to lower potassium levels.²

Know the Symptoms and Risks

Although patients with hyperkalemia do not always present with symptoms, the AKF guidelines emphasize the risks of high potassium, particularly in cardiovascular health, and thus underscore the importance of routine blood testing and being aware of potential signs of hyperkalemia. Specifically, they reference feeling tired or weak; nausea; muscle pains or cramps; trouble breathing; and unusual heartbeat or chest pain as symptoms to monitor for high potassium.²

Given the increased risk of heart attacks in patients with hyperkalemia, the guidelines also outline signs of heart attack to be aware of, including feelings of pressure, pain, or squeezing in your chest or arms; stomach pain or nausea; shortness of breath; breaking into a cold sweat; and sudden feelings of dizziness.²

Developing, Understanding Your Treatment Plan

The final component of the guidelines outlines what patients can expect from their personalized treatment plan. In addition to advising against taking certain medicines that can raise potassium levels, such as nonsteroidal anti-inflammatory drugs like ibuprofen, providers may prescribe medications to help lower potassium levels, such as diuretics, sodium bicarbonate, and potassium binders.²

Patients taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and still experiencing high potassium levels despite taking the previously mentioned steps may be told to lower their dose or pause their medicine. However, this is typically the last step a provider will take because these medicines play a large role in controlling blood pressure and maintaining kidney health.²

Diet can also play a key role in managing potassium levels, and a dietitian can help create a low-potassium food and fluid plan limiting potassium intake to 2,000 – 3,000mg per day. The following may also help patients adhere to their low-potassium diet:

• Drain juice, syrup, and liquids from canned fruits and vegetables
• Avoid salt substitutes and other seasonings with potassium
• Read labels on packaged foods and avoid foods with potassium chloride
• Boil vegetables instead of steaming or microwaving them

References

1. ^{American Kidney Fund. New Guidelines from the American Kidney Fund Will Help People with Chronic Kidney Disease Manage High Potassium. July 11, 2024. Accessed July 12, 2024. https://www.kidneyfund.org/article/new-guidelines-american-kidney-fund-will-help-people-chronic-kidney-disease-manage-high-potassium?check_logged_in=1}
2. ^{American Kidney Fund. Kidney disease guidelines to manage and treat high potassium. July 11, 2024. Accessed July 12, 2024. https://www.kidneyfund.org/living-kidney-disease/health-problems-caused-kidney-disease/high-potassium-guidelines}
3. ^{National Kidney Foundation. Facts About High Potassium in Patients with Kidney Disease. Accessed July 12, 2024. https://www.kidney.org/atoz/content/hyperkalemia/facts}