Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future

WOS: 000389086800058
PubMed ID: 27693804
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. (C) 2016 Elsevier Ltd. All rights reserved.
ZS Pharma
This work was generated from discussions during a workshop held in New York in May 2015. It was set-up jointly by the FCRIN (French Clinical Research Infrastructure Network), INI-CRCT, Nancy, France, and CVCT (Cardiovascular Clinical Trialists), under the framework of the Clinical Investigation Center (CIC) Inserm, CHU, and University of Lorraine, France, and endorsed by the GREAT acute conditions care international network. The meeting was funded by an unrestricted educational grant from ZS Pharma. ZS Pharma had no involvement in preparation, review, or approval of the manuscript for publication. PR (the corresponding author) had final responsibility for the decision to submit for publication.