Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
No recommendations possible based on Level I or II evidence
Suggestions for Clinical Care
(Suggestions are based on Level III and IV evidence)
- Serum potassium should be regularly monitored, and a reduced potassium diet commenced when serum potassium is greater than 5.5 mmol/L. (Opinion)
The risk of cardiac arrhythmias is higher when the potassium is above 6.5 mmol/L or when the potassium is below 3.0 mmol/L. Patients who are especially at risk of cardiac arrhythmias are those with ischaemic heart disease, previous arrhythmias, or low serum calcium.
Potassium excretion is maintained in renal disease unless distal tubular urine flows or aldosterone secretion is affected.
When hyperkalaemia develops in the chronic kidney disease (CKD) patient, one of the following should be looked for, and when possible, corrected:
- High potassium intake (including salt substitutes in sodium-reduced diets)
- Oliguria
- Hypoaldosteronism
- Metabolic acidosis
- Medications that either contain potassium or inhibit the clearance of potassium, such as angiotensin-converting enzyme (ACE) inhibitors, corticosteroids, and potassium-sparing diuretics
Conversely, hypokalaemia may develop in the CKD patient when:
- A low potassium diet is implemented, including poor/low food nutrition intake
- Overuse or inappropriate use of potassium-lowering agents is occurring, e.g. ion-exchange resins
- Overuse or inappropriate use of diuretics is present
A reduced potassium diet should limit the 24-hour intake to approximately 80 mmol.
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test