Hyperkalemia treated with medical management vs hemodialysis (HD) leads to comparable results, researchers reported at Kidney Week 2021, a virtual meeting of the American Society of Nephrology.

In a retrospective study of 569 patients presenting with serum potassium levels of 5.5 mmol/L or higher during 682 medical visits, patients were treated with HD (with or without medication) during 64 visits (9%)  and treated with medications exclusively during 618 visits (91%) within 3 hours. The medical management group received insulin, dextrose, sodium zirconium cyclosilicate, calcium gluconate, albuterol, or furosemide for treatment. The mean initial potassium levels were 6.45 and 6.21 mmol/L in the HD and medical management groups, respectively – a nonsignificant difference.

Serum potassium declined similarly in both groups over time to 4.5-5.0 mmol/L in the HD group and 4.4-5.1 mmol/L in the medical management group, Joseph Aaron Gotesman, MD, and Maria V. DeVita, MD, of Lenox Hill Hospital in New York, New York, reported.

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While these results need to be reproduced in larger studies and randomized trials, the potential clinical implications of this retrospective data are vast, Dr Gotesman told Renal & Urology News in an interview.

“Hyperkalemia affects nearly every field of medicine. Our ability as physicians to treat this disease with medical management [exclusively] would allow for expedient, consistent, and evidence-based care. Nationally standardized treatment algorithms ought to be developed.”


Gotesman JA, DeVita MV. Hyperkalemia: medical management vs. hemodialysis. Presented at: Kidney Week 2021; November 2-7, 2021. Poster: PO0892.