To prevent hyperkalemia (excess potassium), attention must be paid to reducing individual risk factors.
Behavioral risk factors
- Diet
- Fasting
- Increased intake of potassium; hyperkalemia due to increased dietary potassium intake occurs only in patients with impaired renal function (most common cause of hyperkalemia)
Prevention factors (protective factors)
Guidelines recommend discontinuation of medications with pharmacologic RAAS inhibition starting at potassium levels of 5-6 mmol/l.
The following are recommendations for RAAS inhibitors (renin-angiotensin-aldosterone system inhibitors) in hyperkalemia:
| Guidelines | Potassium (mmol/l) | RAAS inhibitor recommendations |
| European Society of Hypertension (ESH)/European Society of Cardiology (ESC), Hypertension Guideline. | – | ACE inhibitors, AT1 blockers, aldosterone antagonists contraindicated in hyperkalemia |
| Kidney Disease Outcomes Quality Initiative (KDOQI). | > 5 | Dose reduction of ACE inhibitor/AT1 blocker by 50%; discontinue if concentration is still > 5 mmol/l after 2 weeks |
| > 5,5 | ACE inhibitors/AT1 blockers should not be used or should be used with caution | |
| American College of Cardiology Foundation (ACCF)/American Heart Association (AHA). | > 5,5 | Dose reduction or discontinuation of ACE inhibitors, AT1 blockers, aldosterone antagonists. |
Legend
- ACE (angiotensin-converting enzyme).
- AT 1 blocker (angiotensin II receptor type 1 blocker).
Note: Discontinuation of RAAS inhibitors should be guided by these guidelines, esp. in patients with renal insufficiency (kidney failure) and congestive heart failure (heart failure), because these patient groups particularly benefit from therapy. In patients with renal insufficiency, RAAS inhibition leads to slowing of proteinuria (increased excretion of protein in the urine) and secondary renal damage. In patients with heart failure, RAAS inhibition reduces profibrotic remodeling mechanisms of the myocardium (heart muscle) and decreases myocardial hypertrophy (heart muscle enlargement). As a result, this clientele experiences a significant reduction in mortality (death rate).
