Cardiovascular disease treatment and hyperkalemia: A report of three cases

Renin-angiotensin-aldosterone system inhibitors (RAASi) are primarily used for the treatment of hypertension and diabetic/non-diabetic reno-cardiovascular diseases. The present study describes the cases of 3 patients with hyperkalemia that occurred during RAASi therapy and describes the therapeutic approach used for this serious complication. The clinical/laboratory findings of hospitalized patients with hyperkalemia within a short time period (within 30 days) and treatment were recorded. Acute hyperkalemia developed due to angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) and spironolactone in 3 patients, whose cases are reported herein. Insulin glucose infusion (IGI) + salbutamol + potassium binders were used for the treatment of severe hyperkalemia. Acute kidney injury (AKI) regressed in all patients. Hyperkalemia was corrected within 6 h in 1 patient who was treated with sodium zirconium cyclosilicate in addition to IGI. On the whole, the present study demonstrates that hyperkalemia may be symptomatic/asymptomatic and may develop during the earlier or later period of RAASi therapy for cardiovascular-renal disease, particularly in older patients. AKI improved with the correction of hyperkalemia and the discontinuation of ACEi/ARB and spironolactone. Sodium zirconium cyclosilicate may be the preferred treatment in emergency cases of hyperkalemia due to its rapid effects. On the other hand, sodium glucose co-transporter 2 inhibitors and non-steroidal mineralocorticoid receptor antagonists may also be used to avoid the development of hyperkalemia in patients undergoing RAASi therapy.