Egyptian Consensus on Hyperkalemia Management: Lessons from Recent Evidences

Abstract

Acute and chronic hyperkalemia is linked to higher hospitalization rates and mortality rates. It has a high prevalence among dialysis and non-dialysis patients in Egypt. The current therapy options are not that ideal. Moreover, we have a critical management paradox in cardiorenal diseases: Should we use the optimum dose of RAASi with its higher incidence of HK, or should we decrease the dose or even stop it with all its harmful hazards ? Therefore, in light of the recent updates in different clinical practice guidelines, we, a country-specific (Egypt) task force, gathered to develop a clear, evidence-based, and multi-disciplinary consensus for managing HK. This manuscript illustrates the recommendations of this expert committee. The panel recommends new evidenced K binders like Sodium Zirconium Cyclosilicate (SZC) and patiromer to help manage HK in cardiorenal patients as stated by different international guidelines. In emergency settings, SZC can have a role in managing acute HK; however, it should be used in addition to other drugs like insulin and glucose. Local research studies on the utilization of these novel K binders are highly recommended. The utilization of these novel K binders as prophylaxis should be tested first in a well-designed randomized controlled trial.