We recommend that the treatment of hyperkalaemia in patients in the community and out patient setting is guided by its severity and clinical condition of the patient as summarised in the treatment algorithm. (1B)
Rationale (Guideline 12.1)
Hyperkalaemia is commonly detected in the community and the approach to monitoring and treatment is variable. An algorithm has been designed to assist clinicians in the outpatient and primary care settings as shown in Appendix 6.
Patients with a serum K+ < 5.5 mmol/l do not require any specific treatment. Patients with persistent mild hyperkalaemia (K+ 5.5 – 5.9 mmol/l) warrant a review of medication (e.g., RAASi) and dietary K+ intake. The threshold for consideration of a potassium binder has been lowered to include patients with mild hyperkalaemia if meets NICE criteria (see Guideline 10.1). Treatment of metabolic acidosis (serum bicarbonate < 22 mmol/l) and initiation of diuretics may be helpful in chronic hyperkalaemia.
Patients with persistent moderate hyperkalaemia (K⁺ 6.0 – 6.4 mmol/l) who are not acutely unwell require similar considerations; however, some may be candidates for a K⁺ binder.
Patients with moderate hyperkalaemia who are acutely unwell and those with severe hyperkalaemia (K⁺ ≥ 6.5 mmol/l) warrant referral to hospital for urgent assessment.
Blood monitoring is essential after a hyperkalaemic event, and the urgency is guided by the severity. Recurrence of hyperkalaemia is common, particularly in patients with CKD; therefore, it is important to consider preventative measures.