Clinical practice guidelines treatment of acute hyperkalaemia in adults

Clinical practice guidelines treatment of acute hyperkalaemia in adults - UK Kidney Association

Purpose of Guideline Update:
An update of the UKKA Hyperkalaemia Guideline (2020) was prompted following enquiries related to the administration of Calcium Gluconate and to provide new guidance related to the use of oral potassium binders and blood glucose monitoring. Therefore, the main changes to treatment recommendations are within the Hospital Section of this update.

The MHRA have recently commissioned a review of the clinical indications, dosage, rate and method of administration of Calcium Gluconate following which a patient safety alert and prescribing guidance has been issued pertaining to the treatment of hyperkalaemia.

Feedback was also received that suggested greater emphasis was required to highlight the 2-stage Insulinglucose regimen in the original hospital treatment algorithm (2020). In response, an amendment was issued in August 2022. This has been included in the update as there is now new evidence to support the proposed threshold (blood glucose < 7 mmol/l) for administering a 5-hour infusion of 10% glucose following Insulin-glucose.

We have also reviewed blood glucose monitoring in light of growing evidence that a 6-hour period may be adequate. This change reverts to the 2014 protocol and may help to improve adherence in clinical practice. There remains insufficient evidence to alter the insulin dosing regimen.

Clinical experience is growing for the use of the novel potassium binders, Sodium Zirconium Cyclosilicate and Patiromer which are both licensed for treatment of hyperkalaemia in adults. Further studies have been undertaken in the acute setting and have been included in this update. There now appears to be no role for Calcium Resonium in the acute setting.

The Hyperkalaemia Algorithm (Hospital) has been updated to reflect all changes outlined in this update including the rate of administration of IV calcium salts, the wider scope for use of the novel potassium binders to include both moderate and severe hyperkalaemia, the removal of calcium resonium and the modified blood glucose monitoring regimen.

The Community and Resuscitation sections have also been reviewed and updated, although there are no major changes to clinical practice.


Read full Guideline