Emergency management of severe hyperkalemia

Guideline for best practice and opportunities for the future

Patrick Rossignol, Matthieu Legrand, Mikhail Kosiborod, Steven M. Hollenberg, W. Frank Peacock, Michael Emmett, Murray Epstein, Csaba Kovesdy, Mehmet Birhan Yilmaz, Wendy Gattis Stough, Etienne Gayat, Bertram Pitt, Faiez Zannad, Alexandre Mebazaa

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Hyperkalemia is a common electrolyte disorder, especially in chronic kidney disease, diabetes mellitus, or heart failure. Hyperkalemia can lead to potentially fatal cardiac dysrhythmias, and it is associated with increased mortality. Determining whether emergency therapy is warranted is largely based on subjective clinical judgment. The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT) aimed to evaluate the current knowledge pertaining to the emergency treatment of hyperkalemia. The INI-CRCT developed a treatment algorithm reflecting expert opinion of best practices in the context of current evidence, identified gaps in knowledge, and set priorities for future research. We searched PubMed (to August 4, 2015) for consensus guidelines, reviews, randomized clinical trials, and observational studies, limited to English language but not by publication date. Treatment approaches are based on small studies, anecdotal experience, and traditional practice patterns. The safety and real-world effectiveness of standard therapies remain unproven. Prospective research is needed and should include studies to better characterize the population, define the serum potassium thresholds where life-threatening arrhythmias are imminent, assess the potassium and electrocardiogram response to standard interventions. Randomized, controlled trials are needed to test the safety and efficacy of new potassium binders for the emergency treatment of severe hyperkalemia in hemodynamically stable patients. Existing emergency treatments for severe hyperkalemia are not supported by a compelling body of evidence, and they are used inconsistently across institutions, with potentially significant associated side effects. Further research is needed to fill knowledge gaps, and definitive clinical trials are needed to better define optimal management strategies, and ultimately to improve outcomes in these patients.

Original languageEnglish (US)
Pages (from-to)585-591
Number of pages7
JournalPharmacological Research
Volume113
DOIs
StatePublished - Nov 1 2016

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Hyperkalemia
Practice Guidelines
Emergency Treatment
Emergencies
Guidelines
Potassium
Cardiac Arrhythmias
Randomized Controlled Trials
Research Personnel
Kidney
Safety
Expert Testimony
Chronic Renal Insufficiency
Research
PubMed
Electrolytes
Observational Studies
Publications
Consensus
Diabetes Mellitus

All Science Journal Classification (ASJC) codes

  • Pharmacology

Cite this

Rossignol, P., Legrand, M., Kosiborod, M., Hollenberg, S. M., Peacock, W. F., Emmett, M., ... Mebazaa, A. (2016). Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future. Pharmacological Research, 113, 585-591. https://doi.org/10.1016/j.phrs.2016.09.039

Emergency management of severe hyperkalemia : Guideline for best practice and opportunities for the future. / Rossignol, Patrick; Legrand, Matthieu; Kosiborod, Mikhail; Hollenberg, Steven M.; Peacock, W. Frank; Emmett, Michael; Epstein, Murray; Kovesdy, Csaba; Yilmaz, Mehmet Birhan; Stough, Wendy Gattis; Gayat, Etienne; Pitt, Bertram; Zannad, Faiez; Mebazaa, Alexandre.

In: Pharmacological Research, Vol. 113, 01.11.2016, p. 585-591.

Research output: Contribution to journalReview article

Rossignol, P, Legrand, M, Kosiborod, M, Hollenberg, SM, Peacock, WF, Emmett, M, Epstein, M, Kovesdy, C, Yilmaz, MB, Stough, WG, Gayat, E, Pitt, B, Zannad, F & Mebazaa, A 2016, 'Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future', Pharmacological Research, vol. 113, pp. 585-591. https://doi.org/10.1016/j.phrs.2016.09.039
Rossignol, Patrick ; Legrand, Matthieu ; Kosiborod, Mikhail ; Hollenberg, Steven M. ; Peacock, W. Frank ; Emmett, Michael ; Epstein, Murray ; Kovesdy, Csaba ; Yilmaz, Mehmet Birhan ; Stough, Wendy Gattis ; Gayat, Etienne ; Pitt, Bertram ; Zannad, Faiez ; Mebazaa, Alexandre. / Emergency management of severe hyperkalemia : Guideline for best practice and opportunities for the future. In: Pharmacological Research. 2016 ; Vol. 113. pp. 585-591.
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