Title: Hyperkalemia: Present and Future

Biography:

Rajesh Sherke is a Senior Consultant Nephrologist at Al Qassimi Hospital in Sharjah, United Arab Emirates. He has also worked as a consultant nephrologist in the Ministry of Health and Prevention in UAE.

Abstract

Hyperkalemia is a potentially serious medical condition in which elevated serum potassium levels can increase the risk of severe cardiac electrophysiology abnormalities (e.g., cardiac arrhythmias) and sudden death. Modulation of the renin-angiotensin-aldosterone system (RAAS) in reducing disease progression and in improving the outcome in heart failure and chronic kidney disease is very well documented and is recommended in respective guidelines. Unfortunately, patients with heart failure and chronic kidney disease are at greater risk of hyperkalemia with RAAS inhibitors than those without these conditions. Prescribing of renin-angiotensin inhibitors and mineralocorticoid antagonists is often limited by the occurrence of hyperkalemia and further, underutilization of these potentially beneficial medications inconsistent with established guidelines is common due to perceived risk of hyperkalemia. Although, there are effective management strategies in the treatment of acute hyperkalemia, the long-term management of hyperkalemia often requires withdrawing or reducing the doses of drugs proven to improve the outcome of heart failure and chronic kidney disease and/or implementing severe and sometimes intolerable dietary potassium restrictions. Withdrawal of RAAS inhibitors leads to increased morbidity and mortality consequent to rapid disease progression resulting in incremental healthcare costs. On the contrary, hyperkalemia itself is associated with significant adverse clinical outcomes and incremental financial burden. The presence of hyperkalemia is a big risk factor for all-cause mortality regardless of the kidney function and results in increased emergency department visits and hospitalizations with economic consequences. There is an unmet need for long-term treatment strategies for hyperkalemia. The new potassium binders (patiromer and zirconium cyclosilicate) have extended novel treatment options for chronic hyperkalemia allowing the use of RAAS inhibitors.