Hyperkalaemia in the age of aldosterone antagonism

Hyperkalaemia is well recognized as a medical emergency. However, with the publication of trials showing benefit with renin-aldosterone axis suppression in heart failure, the epidemiology of patients presenting with hyperkalaemia has changed. The reported incidence of rate of serious hyperkalaemia (...

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Bibliographic Details
Published in:QJM : An International Journal of Medicine 2012-11, Vol.105 (11), p.1049-1057
Main Authors: CHAPAGAIN, A, ASHMAN, N
Format: Article
Language:English
Subjects:
Algorithms
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Biological and medical sciences
Dose-Response Relationship, Drug
General aspects
Heart Failure - drug therapy
Humans
Hyperkalemia - chemically induced
Hyperkalemia - epidemiology
Medical sciences
Mineralocorticoid Receptor Antagonists - adverse effects
Mineralocorticoid Receptor Antagonists - therapeutic use
Patient Selection
Randomized Controlled Trials as Topic
Risk Factors
Spironolactone - adverse effects
Spironolactone - therapeutic use
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Summary:Hyperkalaemia is well recognized as a medical emergency. However, with the publication of trials showing benefit with renin-aldosterone axis suppression in heart failure, the epidemiology of patients presenting with hyperkalaemia has changed. The reported incidence of rate of serious hyperkalaemia (>6.0 mEq/l of potassium) ranges from 6 to 12% in patients on spironolactone with congestive cardiac failure (CCF). A rational choice of therapy based on present evidence is different from the traditionally used algorithm, given our understanding of the physiology relevant to this patient group. This article discusses the changing face of hyperkalaemia and the present evidence and discusses options in treatment of hyperkalaemia.
ISSN:1460-2725
1460-2393
DOI:10.1093/qjmed/hcs106