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 (>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.
Department of Renal Medicine and Transplantation, St Bartholomew's and the Royal London Hospital, London E1 1BB, UK. ananda.chapagain@bartshealth.nhs.uk
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Chapagain
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Ashman
D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000453:epidemiology; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects* / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone