Hyperkalemia: current concepts and emerging therapeutic options

Abstract

H yperkalemia has long constituted one of the electrolyte abnormalities of interest to clinicians and physiologists, and it represents one of the most important acute electrolyte abnormalities due to its potential for causing life-threatening arrhythmias. Hyperkalemia remains a vexing and challenging problem for clinicians, particularly in the management of patients with chronic kidney disease and cardiovascular disease, especially congestive heart failure. In the past 2 decades, themedical community has witnessed a major increase in its understanding of the physiology of renal potassium handling and the relatively unappreciated role of extrarenal and gut sensors in modulating renal potassium handling. This increased understanding has enhanced the diagnosis of dyskalemias. In recent years, increasing investigative attention has focused on novel physiological paradigms that increase not only the complexity but also the precision of homeostasis. These fundamental investigative breakthroughs have been coupled with a reassessment of the expanding spectrum of clinical disorders that predispose to the development of hyperkalemia. The overriding importance of renin– angiotensin–aldosterone system inhibitors (RAASis) as risk factors of hyperkalemia has been increasingly appreciated. A careful reading of the articles of this supplement should provide clinicians with the information needed to more rationally manage the clinical disorders of dyskalemia with an emphasis on hyperkalemia. The contributors to this supplement were asked to review critically the available literature dealing with specific facets of the normal physiology of renal potassium handling and derangements of renal modulation of potassium that result in diverse dyskalemic disorders. The first article, by Csaba Kovesdy, MD, surveys the epidemiology of hyperkalemia. He examines the currently known incidence and