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Management of hyperkalemia: Expert consensus from Kuwait - a Modified Delphi Approach
Ali AlSahow1, Bassam Bulbanat2, Bassam Alhelal3
1Nephrology division, Jahra Hospital, Al Jahra, Kuwait.
International Journal of Nephrology and Renovascular Disease
|October 10, 2024
Summary
This consensus provides expert guidance on managing hyperkalemia in heart failure, chronic kidney disease, and hemodialysis patients. It addresses inconsistencies in current guidelines for hyperkalemia treatment.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Hyperkalemia is prevalent in heart failure (HF) patients on renin-angiotensin-aldosterone inhibitors (RAASi), chronic kidney disease (CKD), and hemodialysis.
- It complicates patient management and limits the use of essential RAASi therapy.
- New potassium binders like sodium zirconium cyclosilicate (SZC) show efficacy, but inconsistent guidelines hinder their adoption.
Purpose of the Study:
- To develop a consensus statement for hyperkalemia management in acute settings, HF, CKD, and hemodialysis.
- To address the lack of standardized treatment protocols in the Arabian Gulf region.
- To provide practical guidance for healthcare practitioners in Kuwait.
Main Methods:
- A three-step modified Delphi method involving twelve Kuwaiti experts.
- Two rounds of voting with an intervening virtual meeting to discuss non-unanimous statements.
- Development and voting on 44 consensus statements regarding hyperkalemia management.
Main Results:
- The consensus comprises 44 statements covering hyperkalemia management across various clinical settings.
- Thirty-six statements achieved unanimous approval in the first round.
- Four statements were removed and four were approved after revisions in the second round.
Conclusions:
- Standardized definitions, treatment thresholds, and consistent guidelines are lacking for hyperkalemia management.
- This consensus aims to establish a unified approach to hyperkalemia treatment in Kuwait.
- The statement highlights future needs for improved hyperkalemia care.
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