Chronic Hyperkalemia Requires Long-term Management

With the continuous improvement of the quality of life of Chinese residents, the prevalence of various chronic diseases has increased year by year and has become the "public enemy number one" that threatens the health of Chinese residents [1]. The chronic diseases we are traditionally familiar with mainly include diabetes, hypertension, hyperlipidemia, and COPD. These chronic diseases are characterized by high morbidity, high mortality, many complications, a long disease management cycle, and a heavy economic burden of disease. , has become a major health threat to China and the world [2].

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At the same time, chronic hyperkalemia caused by chronic kidney disease (CKD) or heart failure, as one of the important risk factors for all-cause mortality, can cause arrhythmia, neuromuscular weakness, and even life-threatening [3-6]. However, long-term management of chronic hyperkalemia remains elusive due to the insidious occurrence of hyperkalemia and the general lack of awareness of the disease.

As a common electrolyte disorder, hyperkalemia was once considered a transient disease. However, research results in recent years have found that for high-risk groups such as CKD, heart failure, and diabetes, hyperkalemia occurs repeatedly, that is, "chronic hyperkalemia". Guidelines from the American Kidney Foundation define chronic hyperkalemia as hyperkalemia due to impairment of potassium absorption or metabolism, with >1 episode in a year and requiring long-term management [7-8].

What kind of impact will hyperkalemia have on high-risk groups?

Renin-angiotensin-aldosterone system inhibitor (RAASi) is a necessary and beneficial clinical treatment for CKD patients. Adequate use of RAASi can effectively reduce urinary protein and delay the progression of the glomerular filtration rate. However, due to the occurrence of hyperkalemia, the reduction and discontinuation of RAASi will increase the risk of dialysis in CKD patients by a full 65% [9]!

For patients with recurrent hyperkalemia, it will increase the risk of an emergency hospitalization or even emergency intubation, which greatly increases the expenditure on medical resources and seriously affects the quality of life of patients. A Japanese data study showed that chronic onset and recurrence of hyperkalemia significantly increased medical expenses by 5 times [10]. Chinese data showed that among newly diagnosed CKD patients, medical expenses increased by 40,000 yuan a year due to the onset of hyperkalemia, and the patients were hospitalized. The time is increased by 20 days [11]. It can be seen that hyperkalemia has a great and far-reaching impact on CKD patients!

So, how can we better avoid hyperkalemia?

Authoritative guidelines and consensuses at home and abroad since 2020 all indicate that chronic hyperkalemia should be managed long-term to prevent recurrence [12-15]. Concerning these guidelines, after the treatment of acute hyperkalemia, regular blood potassium testing is required, and long-term use of potassium-lowering drugs is required to prevent the recurrence of hyperkalemia.

Especially for patients with middle and advanced chronic kidney disease, these measures are critical to reducing the incidence and mortality of adverse heart and kidney outcomes. According to the recommendations of the guidelines, chronic hyperkalemia is also a chronic disease that requires long-term management. It requires maintaining a low-potassium diet and long-term use of potassium-lowering drugs under the premise of reasonable monitoring of serum potassium.

The long-term management of chronic hyperkalemia requires the joint efforts of clinicians, nursing teams, and patients, and none of them can be dispensed with.

● For clinicians, it is necessary to play a good role in collaborative management, regularly detect blood potassium indicators, intervene and manage the dynamic rising trend of blood potassium in time, pay attention to the harm of blood potassium, and avoid adverse effects caused by repeated episodes of hyperkalemia Influence.

● For nurses, it is necessary to improve the systematic nursing education mechanism, achieve regular and group-specific health education work, formulate different nursing plans according to the needs of different patients and arouse patients' awareness of disease hazards and self-management awareness. It is recommended that nurses assist doctors in strengthening the guidance and management of patient's medication and diet.

● Finally, patients themselves need to recognize the dangers of the disease, follow the doctor's advice, check up on time, take medication, manage their diet well, take care of themselves, and improve their compliance.

The three parties work together to provide patients with more appropriate and high-quality treatment options, greatly improving the quality of life of patients and reducing all-cause mortality.

Conventional potassium-lowering measures include a low-potassium diet, oral diuretics to excrete potassium, and oral cation exchange resins, etc., but these measures have certain limitations: it is difficult to identify the potassium content in food, and it is difficult to adhere to a long-term low-potassium diet; Effective in patients with renal function and risk of hypovolaemia; oral administration of cationic resins may lead to colonic necrosis.

At present, there is a new oral potassium-lowering drug in China—sodium zirconium cyclosilicate. Studies have confirmed that sodium zirconium cyclosilicate can be used for the long-term treatment of hyperkalemia in patients with chronic kidney disease, and can optimize the use of RAASi so that Patients continue to benefit. In terms of safety, it is well tolerated by the digestive tract and will not affect the metabolism of other ions. After corrective treatment to achieve normal potassium levels, the minimum effective dose of sodium zirconium cyclosilicate to prevent the recurrence of hyperkalemia should be determined to avoid the occurrence of hypokalemia.

With the improvement of residents' health needs and the widespread implementation of chronic disease medical insurance policies, more popular and more standardized long-term management of chronic hyperkalemia is particularly important. To benefit more patients with chronic hyperkalemia, let us work together to try to hasten that day.