In chronic kidney disease, excretion of potassium (K+) in the urine is impaired. Levels may also rise with ACE inhibitors and ARBs used to treat hypertension or with use of spironolactone. Levels consistently above 6.0 mmol/l are concern and should be managed. Hyperkalemia, especially levels > 6.5 mmol/l, predisposes to cardiac arrythmias.
- Low K+ diet
- Correct metabolic acidosis (target serum HCO3 > 22 mmol/l)
- Potassium wasting diuretics (e.g. thiazides)
- Avoid salt substitutes which may be high in K+
- Cease ACE inhibitors/ARBs/Spironolactone if K+ persistently >6.0 mmol/l and not responsive to above therapies
- Refer to nearest emergency departement if K+>6.5 mmol/l