Hyperkalemia in CKD Patients? Don’t Panic, The Key To Lowering Blood Potassium Is To Follow These Five Steps

The intake and excretion of potassium in the body can be summed up in one sentence: eat more and excrete more, eat less and excrete less, and even if you don't eat, you will excrete it. Normal adults need potassium 0.4mmol/kg per day, about 3-4g. The main source is food, which is eaten through the mouth. The normal adult blood potassium concentration is 3.5-5.5mmol/L. If it exceeds 5.5mmol/L, it is called hyperkalemia.

Click to Cistanche for kidney disease

The kidneys are the main organs for excreting potassium in the human body. Potassium excretion in urine accounts for 85% of the total potassium excretion in the human body, while feces and sweat account for 10% and 5% respectively. This explains why patients with chronic kidney disease (CKD) are prone to Hyperkalemia occurs.

Because the main potassium excretion organ, the kidneys, is dysfunctional, the potassium that should be excreted is not excreted, and blood potassium will naturally increase.

01 Common causes of hyperkalemia in CKD patients

1 Decreased kidney function and reduced potassium excretion

For CKD patients, hyperkalemia is not likely to occur if the glomerular filtration rate (GFR) is >10ml/min and the daily urine output is >600ml.

But if other risk factors occur at this time, such as oral and intravenous potassium supplementation, or eating potassium-containing foods, such as losartan potassium tablets commonly used in nephrology, commonly used antibacterial drugs amoxicillin and clavulanate potassium, and aldosterone antagonists or renal Drugs that secrete potassium from the tubules are very prone to hyperkalemia. These medications are discussed in detail below.

2 Caused by commonly used drugs in nephrology

Drugs commonly used in nephrology that can increase blood potassium mainly include the following categories.

Potassium-sparing diuretics

Spironolactone is a potassium-sparing diuretic widely used clinically. Its structure is similar to that of aldosterone. It is a competitive inhibitor of aldosterone. By blocking the exchange of Na+-K+ and Na+-H-, it increases the excretion of Na+, Cl-, and water. K+, mg2+, etc. are excreted less and act as potassium-sparing diuretics. Diuretics with similar mechanisms include triamterene and amiloride.

In patients with CKD, these drugs are often combined with potassium-depleting diuretics such as furosemide and torsemide to reduce edema and avoid hypokalemia. It can also prevent ventricular remodeling by blocking aldosterone, and is often used in patients with CKD and heart failure.

Due to its inherent potassium-sparing effect, if it is used in combination with potassium-containing drugs or food, or infused with stored blood, or used in combination with other drugs that affect potassium excretion, be sure to recheck serum potassium, otherwise hyperkalemia may easily occur.

 Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB)

These two types of drugs are commonly used in the treatment of CKD and can reduce proteinuria by reducing GFR. Even CKD patients whose serum creatinine has increased can still be used clinically as long as the indications for discontinuation are not met.

However, this type of drug can reduce the body's aldosterone level, especially when combined with the above-mentioned potassium-sparing diuretics, it will further affect the excretion of potassium, so special attention should be paid when using it.

Immunosuppressants

Cyclosporine and tacrolimus are commonly used drugs to treat kidney diseases. Both of them can redistribute potassium by inhibiting the sodium-potassium pump of the basal membrane. The difference is that cyclosporine can also inhibit COX-2 in macula densa. The expression of K+ causes hypotension and hypoaldosteronemia, and inhibits K+ on-off in the distal nephron and other mechanisms, ultimately leading to the occurrence of hyperkalemia.

In addition, heparin and nonsteroidal anti-inflammatory drugs (NSAIDs) can also cause blood potassium to rise through different mechanisms, so care should be taken when using them.

3 Hyporenin and hypoaldosterone syndrome

Patients and the elderly suffering from diabetes, systemic lupus erythematosus, multiple myeloma, acute glomerulonephritis, renal interstitial diseases and other diseases, due to the inhibition of the plasma renin-angiotensin-aldosterone system (RAAS), The response of the adrenal glomerulosa to angiotensin Ⅱ (Ang Ⅱ) is impaired, which affects the potassium secretion function of the distal renal tubules and is also prone to hyperkalemia. Such patients should pay attention to the review of serum potassium.

In addition, hemolysis of specimens and mechanical damage during venipuncture can also cause pseudohyperkalemia. It is recommended to eliminate the above factors that may cause hyperkalemia and repeat blood draws to recheck serum potassium.

02 Teach you step by step how to treat hyperkalemia

The biggest threat of hyperkalemia to the body is cardiac depression, so the treatment principle is to quickly reduce blood potassium and protect the heart.

1 Use calcium supplements

Because high potassium is very toxic to the myocardium and can cause arrhythmia, and as blood potassium rises, the arrhythmia gradually worsens. When blood potassium reaches 12mmol/L, ventricular arrest may even occur, leading to sudden death.

Therefore, it is recommended to use calcium to protect the myocardium. You can use 10% calcium gluconate or 5% calcium chloride to add 10-20ml to an equal amount of 25% glucose injection. Inject it slowly intravenously. It will take effect in a few minutes and can be repeated. use.

2 Reduce potassium sources

Immediately stop high-potassium diets and drugs that contain potassium or affect potassium excretion; ensure adequate caloric supply to the body, actively control infection, and reduce potassium released by catabolism; remove necrotic tissue from the body and do not use stored blood.

3 Clear blood potassium and take potassium-lowering drugs

Potassium-depleting diuretics: such as furosemide, hydrochlorothiazide, etc., are recommended for intravenous use. It is recommended to choose furosemide with the lowest liver metabolism. Better results can be achieved when combined with thiazides.

In cases of renal insufficiency, such drugs have poor potassium excretion effects. You should pay attention to the maximum dose of each diuretic. The maximum dose of furosemide for intravenous injection is 200 mg/d. Excessive use will not achieve greater effects. Oral potassium-lowering drugs are recommended by the guidelines.

4. Promote the transfer of potassium into cells

Commonly used drugs include the following.

■ Insulin and glucose:

Put ordinary insulin into the glucose injection solution and inject it continuously according to the standard of 1 IU insulin for every 3-4g of sugar. Generally, the blood potassium will start to decrease in 10-20 minutes. Continued use for 4-6 hours can reduce the blood potassium by 0.6 -1.0mmol/L. People with high blood sugar can only inject insulin and repeat the injection if necessary. Regardless of whether the patient has diabetes or not, it is recommended to monitor blood sugar to avoid hypoglycemia.

■ Sodium bicarbonate:

In addition to promoting the entry of potassium into cells, sodium bicarbonate can also increase Na+-K+ exchange in the distal renal tubule and promote urinary potassium excretion. It is especially suitable for patients with renal insufficiency and metabolic acidosis. In addition, it can antagonize the myocardial inhibitory effect of potassium and protect the myocardium. You can use 100-200ml of 5% sodium bicarbonate for intravenous infusion, which will take effect in a few minutes. Do not mix it with calcium gluconate during use, otherwise precipitation will occur.

■ β2-adrenoceptor agonists:

Salbutamol, for example, can also promote the entry of potassium into cells.

5 Dialysis

It is the fastest and most effective measure to lower potassium. It is especially suitable for patients who have reached the uremia stage and have heart failure and metabolic acidosis and who find it difficult to seek medical treatment. If the above measures are ineffective, dialysis can be used.

Summarize

It is recommended that when hyperkalemia occurs, the above methods should be used in combination until the blood potassium drops to the normal range. If the above drugs are used in combination, the blood potassium still cannot be reduced. It is recommended that dialysis be used to reduce potassium as much as possible to protect the patient's life.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.