Hyperkalemia (High Potassium) And Kidney Disease

People with chronic kidney disease (CKD) have a high risk for hyperkalemia. It is one of the most common electrolyte disorders in CKD. Hyperkalemia refers to high levels of potassium in the blood. This is due to kidney dysfunction. “A recent review reports hyperkalemia frequency as high as 40-50% in people with chronic kidney disease compared to 2-3% in the general population.”

Potassium is necessary for muscle function. Especially the muscles that control your heartbeat and breathing. Potassium comes from the foods you eat. The body will use what is needed and then the kidneys will excrete 90% of the potassium and the remaining 10% leaves the body through urine.

Hyperkalemia occurs when the kidneys can not remove enough potassium from the body and it flows back into the bloodstream. “CKD patients with the highest risk include those with diabetes, cardiovascular disease, advanced CKD, transplant recipients, and patients taking renin-angiotensin aldosterone system (RAAS) inhibitors.”

Many people do not experience any symptoms from high potassium levels. But, having high levels in your blood can be dangerous. Hyperkalemia may cause a heart arrhythmia, a heart attack or end-stage renal disease. Symptoms of high potassium are:

• Feeling tired or weak.
• Experiencing nausea or diarrhea.
• Muscle pains or cramps.
• Trouble breathing, unusual heartbeat or chest pains.

“A typical potassium level for adults is between 3.5 and 5.0 millimoles per liter (mmol/L). Hyperkalemia occurs when potassium levels go above 5.5 mmol/L. A potassium level above 6.5 mmol/L can cause heart problems that require immediate medical attention.” Kidney disease is the major contributor to hyperkalemia. A high potassium diet (including potassium supplements) and some medications that treat high blood pressure can also cause potassium levels to rise.

As the severity of hyperkalemia increases, so do the 1-5 stages of chronic kidney disease. Thus, managing the effects of high potassium are vital for optimal health for CKD patients. “The faster the rise in the potassium level, the higher it has reached, and the greater the evidence of cardiotoxicity, the more aggressive therapy should be.” 

Severe hyperkalemia can come on suddenly and cause life-threatening heart changes. Even mild hyperkalemia can damage your heart over time. Some of the quickest ways to alleviate high potassium are:

• Diuretics. Urinating more frequently can rid the body of potassium quickly.
• Medication management. Talk with your doctor about high blood pressure pills.
• Potassium binders. This attaches potassium to your stool that can then leave the body.
• IV Therapy. “‘If you have extremely high potassium levels. They’ll give you an IV infusion of calcium gluconate, which helps protect your heart. Next, they’ll give you an infusion of insulin, which helps move potassium into the blood cells. They may also give you the asthma medication albuterol, which helps lower potassium levels.”
• Dialysis. May be necessary if you are near kidney failure.