[Assessment of the population at risk of hyperkalemia]

Area of Science:

• Cardiology
• Nephrology
• Endocrinology

Background:

• Potassium homeostasis is crucial for cardiac myocyte function, regulated by diet, renal elimination, and the renin-angiotensin-aldosterone system (RAAS).
• Hyperkalemia (high potassium levels) is a significant risk factor for cardiac mortality, particularly in elderly patients with comorbidities like chronic renal failure and heart failure.
• RAAS inhibitor therapies are a major iatrogenic cause of hyperkalemia, with limited use of resin therapies (4.9%) despite high comorbidity rates.

Purpose of the Study:

• To highlight the prevalence and risk factors of hyperkalemia.
• To discuss the limitations of current hyperkalemia management, particularly resin therapy.
• To introduce potential new therapeutic options for hyperkalemia.

Main Methods:

• Analysis of patient demographics and comorbidities associated with hyperkalemia.
• Review of current hyperkalemia management strategies and their adherence.
• Evaluation of the role of RAAS inhibitors and comorbidities in hyperkalemia.

Main Results:

• Hyperkalemia predominantly affects patients over 50 (90%), with 43% over 75.
• Common comorbidities include hypertension (74%), dyslipidemia (56.3%), renal failure (55.2%), diabetes (44.7%), and heart failure (12%).
• Resin therapy adherence is poor, and patients on resins often have more comorbidities and receive RAAS inhibitors.

Conclusions:

• Hyperkalemia is underestimated and requires vigilant monitoring in patients with renal or heart failure.
• Current resin therapies have limitations in long-term adherence and suitability.
• Novel therapies like patiromer show promise in reducing hyperkalemia risks.