Hyperkalemia: High Blood Potassium Levels
Hyperkalemia, or high potassium levels in the blood, is an asymptomatic condition that if not treated can cause abnormal heart rhythms and even sudden death.
For healthy individuals, the kidneys play a major role in maintaining potassium levels by matching potassium intake with potassium excretion. Hyperkalemia occurs when there is a defect in one or more of the mechanisms that maintain this balance, most commonly because excretion of potassium by the kidneys is decreased.
Common in People with Chronic Kidney Disease and/or Heart Failure
People at highest risk for hyperkalemia include those with chronic kidney disease (CKD) and/or heart failure. People with CKD also frequently have other disorders such as diabetes and high blood pressure that put them at increased risk. We estimate that approximately 3 million people in the United States with stage 3 & 4 CKD and/or heart failure have hyperkalemia.1 As the number of people with these conditions continues to climb, primarily due to the aging of the population, more people will develop hyperkalemia:
- More than half of people aged 30 to 64 years are likely to develop CKD during their remaining lifespan.2
- At age 55, almost one in three individuals will develop heart failure during their remaining lifespan.3
Hyperkalemia as a Side Effect
Some medicines that are frequently prescribed to people with CKD and heart failure can cause hyperkalemia as a side effect, such as NSAIDs and beta-blockers. One well documented class of medicines that can cause hyperkalemia as a side effect is renin angiotensin aldosterone system (RAAS) inhibitors, often prescribed to people with CKD and heart failure to help delay disease progression. Commonly prescribed RAAS inhibitor medicines include: Angiotensin receptor blockers (ARBs), Mineralocorticoid receptor antagonists (MRAs), and Angiotensin-converting enzyme (ACE) inhibitors.
Long-Term Management Has Been Challenging
As their kidney function deteriorates, people with CKD may experience a recurrence of hyperkalemia. There are often no warning signs, meaning a person at risk can unknowingly experience increases in potassium recurrently.4 Managing this has long been a challenge for doctors.
Dietary restriction of potassium is an important component of managing hyperkalemia. However, this is difficult because potassium is found in many healthy foods: artichokes, avocados, sirloin steak, hamburger, cantaloupe, grapefruit juice, milk, bananas, orange juice, potatoes, prunes, raisins, squash, tomato paste and tomato juice, among others.5 While treatments are available to acutely lower elevated potassium levels in the blood to reduce the risk of a life-threatening event, there have been limited options to manage the chronic risk of hyperkalemia on a daily basis.
1 USRDS 2011, Truven data and CDC; 2 Pitt B, N Engl J Med, 1999; 3 Zannad F, N Engl J Med, 2011; 4 Einhorn LM, Arch Intern Med, 2009; 5 Weiner ID, Comprehensive Clinical Nephrology, 2010.