Treatment of Persistent Hyperkalemia (K+ ≥ 6.0 mmol/l) in Outpatients with CKD Stage 3b–5 or Heart Failure on Sub-optimal RAASi Therapy
This protocol applies to outpatients with chronic kidney disease (Stage 3b–5, not on dialysis) or heart failure who have confirmed persistent serum K+ ≥ 6.0 mmol/l and are receiving a sub-optimal dose of, or are not receiving, RAASi therapy because of hyperkalaemia.
Clinical Scenario
CKD Stage 3b–5 (not on dialysis) or heart failure — confirmed persistent serum K+ ≥ 6.0 mmol/l — RAASi therapy sub-optimal or withheld due to hyperkalaemia.
Treatment Approach
An oral potassium-binding agent, initiated in secondary care and continued in primary care, forms the basis of this treatment approach — the full protocol specifies the recommended options, their initiation criteria, and monitoring and discontinuation conditions.
Treatment Target
Reduce serum K+ to ≤ 5.0 mmol/l within 1 week of starting treatment.
References
We recommend that Patiromer is an option in the management of persistent hyperkalaemia with a confirmed serum K+ ≥ 6.0 mmol/l in out-patients with CKD Stage 3b-5 (not on dialysis) or heart failure receiving a sub-optimal dose or not receiving RAASi therapy due to hyperkalaemia.
We recommend that Sodium Zirconium Cyclosilicate (SZC) is an option in adults for the management of persistent hyperkalaemia with a confirmed serum K+ ≥ 6.0 mmol/l in patients with CKD Stage 3b-5 (not on dialysis) or heart failure receiving a sub-optimal dose of RAASi therapy.
The proportion of adults with moderate hyperkalaemia (serum K+ 6.0 - 6.4 mmol/l) treated with patiromer who achieved a serum K+ ≤ 5.0 mmol/l within 1 week in the out-patient setting.