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July 14, 2015

Treatment of Hyperkalemia: From “Hyper K+” Strikeout to Home Run?

Author Affiliations
  • 1Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
  • 2Associate Editor, JAMA
JAMA. 2015;314(2):129-130. doi:10.1001/jama.2015.7521

Potassium is a key cation with tightly regulated extracellular concentration. Hyperkalemia, commonly considered present if the potassium concentration exceeds 5.0 mEq/L, appears to be a relatively rare event. Although representative data on hyperkalemia in the overall population are lacking, a study of US veterans indicated a hyperkalemia (defined as potassium concentration ≥5.5 mEq/L) event rate of approximately 4 per 100 person-years, with the majority of events occurring during hospitalizations.1 Individuals in this study were required to have at least 1 hospitalization and 1 outpatient creatinine measurement; thus, it is likely that the population was at higher risk for hyperkalemia. In contrast to the low rate of hyperkalemia in the general population, individuals with certain comorbid conditions, such as chronic kidney disease (CKD), diabetes, or congestive heart failure have been shown to be highly prone to developing hyperkalemia, especially if receiving treatment with inhibitors of the renin-angiotensin-aldosterone system (RAAS), which are often recommended in such patients. For example, in a randomized placebo-controlled trial of losartan in patients with diabetic nephropathy, the cumulative incidence of hyperkalemia (potassium concentration >5.0 mEq/L) was 38.4% in the losartan group.2