Purpose

This guideline provides an updated version of the 2020 UKKA Hyperkalaemia guideline. The main aims are to provide evidence based recommendations for the treatment of chronic hyperkalaemia in the community, acute hyperkalaemia in the hospital setting and to reduce the risk of complications associated with hyperkalaemia itself and its treatment.

Scope

The original Hyperkalaemia Guideline (2014) focussed on the management of hyperkalaemia in secondary care. The 2020 Guideline provided a comprehensive overview of the detection and treatment of hyperkalaemia in the community, hospital and resuscitation settings. The 2023 Guideline provides an update of treatment recommendations in the acute hospital setting.

Review of Evidence

The literature was reviewed using multiple databases PubMed (1960 2023), Ovid MEDLINE (1946 2023), EMBASE (1974 2023), Science Direct (1995 2023), The Cochrane Library (1995 2023), Web of Knowledge (2001 2023) for all studies pertaining to treatment of hyperkalaemia in adults. Websites searches included National Institute for Health and Care Excellence, Scottish Medicines Consortium, Healthcare Improvement Scotland, Medicines and Healthcare products Regulatory Agency and European Medicines Agency.

The keywords used for literature search were – hyperkalaemia, potassium, treatment, pseudohyperkalaemia, spurious hyperkalaemia, ECG, point or care, near patient testing, insulin, hypoglycaemia, salbutamol, calcium, bicarbonate, diet, resonium, patiromer, sodium zirconium cyclosilicate, dialysis, arrhythmias, resuscitation, and cardiac arrest.

The writing process followed the UK Kidney Association Guideline development manual. The guideline comprises a series of guideline statements accompanied by supporting evidence and audit measures. The recommendations in each guideline statement have been graded using the GRADE system (www.gradeworkinggroup.org) in evaluating the strength of each recommendation (1 = strong, 2 = weak) and quality of evidence (A= high, B = moderate, C= low, D = very low). Each guideline statement begins with a recommendation (Grade 1 evidence) or a suggestion (Grade 2 evidence).