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<p>This article is part of a review series on water and electrolyte disorders, based on the annual “Electrolyte Winter Seminar” for early-career nephrologists in Japan. The seminar features interactive case-based discussions, some of which are included as self-assessment questions. The fifth installment addresses the management of hyperkalemia. Hyperkalemia frequently occurs in patients with chronic kidney disease (CKD) and can become life-threatening when severe, necessitating prompt treatment regardless of its underlying cause. Renin–angiotensin system inhibitors (RASi) are a recognized risk factor for hyperkalemia in CKD; however, discontinuing RASi in response to elevated potassium levels may adversely affect patient outcomes. Although there are no formal criteria distinguishing acute from chronic hyperkalemia, symptoms presentation and potassium levels offer a practical guide for clinical management. This review covers standard treatment strategies for severe (symptomatic or acute) hyperkalemia in emergency and inpatient settings and discusses how to manage mild-to-moderate (asymptomatic or chronic) cases in CKD patients while continuing RASi therapy.</p>

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Management of hyperkalemia: strategic clinical actions in real-world practice

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月24日

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  • Takuya Fujimaru,
  • Kazuhito Hirose,
  • Masahiko Yazawa,
  • Masahiko Nagahama,
  • Csaba P. Kovesdy,
  • Yoshiro Fujita,
  • Kyogo Kawada,
  • Toshiaki Monkawa,
  • Masatomo Ogata,
  • Akihiro Ryuge,
  • Yugo Shibagaki,
  • Hideaki Shimizu,
  • Hirofumi Sumi,
  • Maho Terashita,
  • Naoto Tominaga

摘要

This article is part of a review series on water and electrolyte disorders, based on the annual “Electrolyte Winter Seminar” for early-career nephrologists in Japan. The seminar features interactive case-based discussions, some of which are included as self-assessment questions. The fifth installment addresses the management of hyperkalemia. Hyperkalemia frequently occurs in patients with chronic kidney disease (CKD) and can become life-threatening when severe, necessitating prompt treatment regardless of its underlying cause. Renin–angiotensin system inhibitors (RASi) are a recognized risk factor for hyperkalemia in CKD; however, discontinuing RASi in response to elevated potassium levels may adversely affect patient outcomes. Although there are no formal criteria distinguishing acute from chronic hyperkalemia, symptoms presentation and potassium levels offer a practical guide for clinical management. This review covers standard treatment strategies for severe (symptomatic or acute) hyperkalemia in emergency and inpatient settings and discusses how to manage mild-to-moderate (asymptomatic or chronic) cases in CKD patients while continuing RASi therapy.