Management of Hyperkalemia in Renin-Angiotensin-Aldosterone System Inhibitor: Strategies to Maintain Chronic Kidney Disease Patients with Type II Diabetes on Therapy

Abstract

Plain Language SummaryDiabetes is a major health problem worldwide. Many adults in the USA have either prediabetes or type II diabetes (T2D), encompassing >50% of adult US population. Chronic kidney disease (CKD) is a common complication that comes with T2D and is often associated with a higher chance of heart problems. When caring for CKD patients with T2D, certain medicines, such as renin-angiotensin-aldosterone system inhibitors (RAASis), are important because they have beneficial effects in delaying CKD progression and decreasing blood pressure. However, healthcare professionals should be careful in maintaining satisfactory kidney blood flow and glomerular pressure (a specific part of the kidneys) while using these medicines. These medicines can also cause high potassium levels in the blood (hyperkalemia), which is dangerous. In the early stages of kidney disease, a medicine like finerenone could help slow kidney disease progression and reduce heart problems while having a relatively low risk of triggering high potassium compared to other RAASi. To ensure patients can keep taking kidney-boosting medicines without major problems, it is crucial to regularly check their potassium levels and make a personalized plan for each person. This article will describe the prerequisites and strategies to keep CKD patients with T2D on RAASi therapy. These approaches might include checking patients’ baseline characteristics and medical history, changes in their diet, and trying new medicines that can help control potassium levels. Overall, these steps can ensure that the kidney medicines work well and prevent the severe problem of high potassium.