Managing Hyperkalemia in the Modern Era: A Case-Based Approach

Area of Science:

• Nephrology and Endocrinology
• Cardiovascular Medicine

Background:

• Recurrent hyperkalemia poses significant clinical challenges, often necessitating discontinuation of vital medications.
• Management strategies have evolved, particularly concerning renin-angiotensin-aldosterone system inhibitors (RAASi) and mineralocorticoid receptor antagonists (MRAs).

Purpose of the Study:

• To provide a contemporary overview of hyperkalemia epidemiology and management.
• To highlight recent advancements in preventing and treating recurrent hyperkalemia.
• To synthesize current evidence on novel therapeutic agents and dietary considerations.

Main Methods:

• Narrative review of recent research findings.
• Case-based format to illustrate clinical scenarios.
• Focus on drug-induced hyperkalemia, concurrent therapies, new binding agents, and dietary potassium.

Main Results:

• RAASi discontinuation can be mitigated by MRAs and newer potassium binders.
• Sodium-glucose transporter 2 inhibitors (SGLT2i) influence potassium handling and hyperkalemia risk.
• Oral potassium binders offer new therapeutic options for managing hyperkalemia.
• The role of dietary potassium restriction remains a subject of ongoing debate.

Conclusions:

• Contemporary management of recurrent hyperkalemia involves a multi-faceted approach.
• Newer agents and therapies offer improved strategies for potassium balance.
• Personalized management considering drug interactions and dietary factors is crucial.