Kidney Week Educational Symposia-Knowing Your Options: Understanding Therapies for Hyperkalemia Management to Aid Decision-Making with Patients Treated with Hemodialysis

Knowing Your Options: Understanding Therapies for Hyperkalemia Management to Aid Decision-Making with Patients Treated with Hemodialysis

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Video Summary

This American Society of Nephrology session reviews hyperkalemia management in patients receiving hemodialysis. Predialysis potassium ≥5.5 mEq/L occurs in ~16–17% monthly, and mortality risk rises significantly around ≥5.7 mEq/L. Hyperkalemia also complicates use of cardio- and reno-protective therapies (ACEi/ARBs and mineralocorticoid receptor antagonists) and increases risks such as arrhythmias, neuromuscular symptoms, and impaired acidification.<br /><br />Dr. Shivam Joshi discusses nonpharmacologic strategies. Evidence shows dietary potassium correlates weakly, if at all, with serum potassium, and plant-food intake generally does not raise potassium in dialysis cohorts. Possible protective factors include alkali, fiber-related effects (improved insulin sensitivity and increased stool potassium losses), and lower bioavailability of potassium from intact plant cells. Key dietary exceptions include concentrated sources—juices, sauces, dried fruits—as well as potassium supplements and salt substitutes. Because colonic potassium secretion increases in kidney failure, addressing constipation (common in dialysis) and increasing tolerated fiber may aid potassium control. Clinicians should also evaluate nondietary causes (undertreatment, acidosis, exercise before labs, medications, lab artifacts).<br /><br />Dr. Shweta Bansal reviews pharmacologic options: sodium polystyrene sulfonate (limited data; constipation and sorbitol-associated bowel injury), patiromer (calcium-based; slower onset; hypomagnesemia), and sodium zirconium cyclosilicate/ZS-9 (rapid onset; sodium load/edema). Trials show patiromer and ZS-9 effectively lower potassium and may enable continuation of RAASi/MRA therapy, though hard-outcome benefits remain under study.

Asset Subtitle

Moderators: Donald Wesson

Speakers:

Introduction - Donald Wesson
Non-Pharmacological Approaches to Prevent Hyperkalemia in Patients Treated with Hemodialysis - Shivam Joshi
Pharmacological Options for Potassium-Lowering and Their Potential Benefits Beyond Hyperkalemia Management - Shweta Bansal

Meta Tag

Date 11/6/2021

Pathway 1 Dialysis

Pathway 2 Cell and Transport Physiology

Session ID 408419

Session Type ES - Educational Symposium

Keywords

hyperkalemia

hemodialysis

predialysis potassium

dietary potassium

plant-based diet

constipation management

RAAS inhibitors

patiromer

sodium zirconium cyclosilicate