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Hyperkalemia in patients undergoing hemodialysis: Its pathophysiology and management

Shigeru Shibata1, Shunya Uchida1,2

  • 1Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.

Therapeutic Apheresis and Dialysis : Official Peer-Reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
|August 11, 2021
PubMed

Insights

Hyperkalemia is common in maintenance hemodialysis (MHD) patients due to kidney dysfunction. This review covers potassium regulation, focusing on extra-renal pathways and management strategies for MHD patients.

Area of Science:

  • Nephrology
  • Physiology
  • Internal Medicine

Background:

  • Potassium is a critical intracellular cation regulating excitable cell membrane potential.
  • Kidney dysfunction, common in maintenance hemodialysis (MHD) patients, disrupts potassium balance, leading to hyperkalemia.
  • Comorbid conditions can alter potassium distribution, contributing to dyskalemia in MHD patients.

Purpose of the Study:

  • To review potassium physiology in MHD patients, highlighting changes from normal kidney function.
  • To emphasize the role of extra-renal potassium elimination, including gastrointestinal pathways.
  • To summarize current management strategies for dyskalemia in MHD.

Main Methods:

  • Literature review of potassium physiology in MHD patients.
  • Emphasis on changes compared to individuals with normal kidney function.
  • Summary of recent findings on dietary, dialysate, and pharmacological therapies.

Main Results:

  • Reduced renal potassium excretion is a primary cause of hyperkalemia in MHD.
  • Extra-renal potassium elimination, particularly via the gastrointestinal tract, is significant.
  • Inhibitors of the renin-angiotensin-aldosterone system can impact extra-renal potassium elimination.

Conclusions:

  • Understanding potassium shifts in MHD patients is crucial for managing dyskalemia.
  • Extra-renal potassium elimination pathways offer therapeutic targets.
  • Comprehensive management involves dietary, dialysate, and pharmacological interventions.

Keywords:
electrolyte homeostasisextra-renal potassium secretionhemodialysisplant-based dietrenin-angiotensin-aldosterone system inhibitors

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