Managing high potassium levels in chronic kidney disease (CKD)
High potassium levels (aka hyperkalemia) can be a problem for people living with CKD.
When blood levels of potassium get too high, it can be dangerous for the heart and even cause cardiac arrest.
It can also be a limiting factor for adding, maintaining or achieving the correct dose for many heart and kidney medications.
Eg ACE inhibitors, angiotensin II receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA).
High potassium is a common reason why patients are often not given important medications. These are medications that can reduce the risk of serious complications or death in many diseases.
So here are some top strategies to keep blood potassium levels under control.
1. Change your diet
Many foods are quite rich in potassium, eg potatoes, tomatoes, bananas, etc.
Review and limit the potassium in your diet. Consider getting the help of a dietician.
2. Avoid salt substitutes
Most salt substitutes replace sodium, typically found in table salt, with potassium.
3. Add a diuretic
Many people have high blood pressure and require medication to control their blood pressure. Diuretics such a thiazide and thiazide-like diuretics can control blood pressure while also enriching the urine with potassium so that the body loses more potassium.
Most diuretics will increase urine wasting of potassium (except potassium sparing diuretics).
4. Avoid or replace medications that raise potassium
Sample medications include trimethoprim-sulfamethoxazole (a commonly used antibiotic), digoxin, amiloride, anti-inflammatories such as ibuprofen, and others.
While drugs like ACE inhibitors, angiotensin II receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) can increase potassium, they may need to be continued to ensure one can benefit from them. Of course, if they aren't indicated, it might be time to reconsider those medications if potassium is an issue.
5. Search for and fix increased body release of potassium
Our cells are full of high levels of potassium. Any disorder that causes cells to rapidly breakdown can release potassium into the blood where it can can harm.
Examples include gastrointestinal bleeding, hemolytic anemia, gangrene and tumour lysis syndrome.
6. Use an SGLT2 inhibitor
This class of medication has been shown to be very helpful in diabetes, chronic kidney disease and heart failure.
There is also new data which suggests it can lower potassium or reduce the risk of high potassium.
7. Correct metabolic acidosis
Metabolic acidosis, in some circumstance, can drive potassium out of cells and into the bloodstream.
It has many causes, but commonly seen in chronic kidney disease or diarrhea.
It can easily be detected by a blood test for bicarbonate levels (HCO3-).
In some cases, it can be corrected by taking sodium bicarbonate supplements.
8. Correct high blood sugars
High blood sugars or inadequate insulin levels in the body can sometimes lead to potassium leaving the cells and entering the blood stream.
Correct high blood sugar levels by working with your doctor to get your diabetes under better control.
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