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The burden of hyperkalaemia in chronic kidney disease: a systematic literature review

Jürgen Floege1, Andrew H Frankel2, Kevin F Erickson3

  • 1Division of Nephrology and Dept of Cardiology, RWTH Aachen University, Aachen, Germany.

Clinical Kidney Journal
|May 19, 2025
PubMed

Insights

Hyperkalaemia in chronic kidney disease (CKD) patients is common and linked to adverse outcomes. Managing this condition, especially with renin-angiotensin-aldosterone system inhibitors (RAASi), requires careful consideration due to significant health and economic impacts.

Area of Science:

  • Nephrology
  • Pharmacology
  • Public Health

Background:

  • Hyperkalaemia is a common complication in chronic kidney disease (CKD) patients.
  • Inconsistent definitions obscure the true global epidemiology and burden of hyperkalaemia.
  • Understanding hyperkalaemia is crucial due to adverse effects and drug interactions, particularly with renin-angiotensin-aldosterone system inhibitors (RAASi).

Purpose of the Study:

  • To systematically review and summarize evidence on hyperkalaemia risk factors in adult CKD patients.
  • To describe characteristics associated with hyperkalaemia, including the impact of sub-optimal RAASi use.
  • To explore the clinical and economic outcomes of hyperkalaemia in CKD.

Main Methods:

  • Systematic literature review of Medline and Embase databases (2000-2024) with hand searching.
  • Screening by two independent reviewers; data extraction and quality assessment by separate reviewers.
  • Descriptive summarization of identified studies.

Main Results:

  • 138 studies (145 publications) met eligibility criteria.
  • Hyperkalaemia prevalence varies with definitions but is significantly increased in CKD patients, irrespective of RAASi treatment.
  • Hyperkalaemia is associated with adverse outcomes, increased healthcare resource utilization, and negative economic impacts, particularly with sub-optimal RAASi dosing in CKD patients with or without heart failure.

Conclusions:

  • This review provides a comprehensive overview of hyperkalaemia in CKD, focusing on clinical and economic outcomes.
  • The interplay between hyperkalaemia risks and sub-optimal RAASi dosing necessitates further research.
  • Clinicians must exercise caution when managing hyperkalaemia in CKD patients.
Abstract

Keywords:
CKDRAASiepidemiologyhealth and economic outcomeshyperkalaemiasub-optimal dosing

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