Egyptian Consensus on Hyperkalemia Management: Lessons from Recent Evidences

Acute and chronic hyperkalemia is linked to higher hospitalization rates and mortality rates. It has a high prevalence among dialysis and non-dialysis patients in Egypt. The current therapy options are not that ideal. Moreover, we have a critical management paradox in cardiorenal diseases: Should we use the optimum dose of RAASi with its higher incidence of HK, or should we decrease the dose or even stop it with all its harmful hazards? Therefore, in light of the recent updates in different clinical practice guidelines, we, a country-specific (Egypt) task force, gathered to develop a clear, evidence-based, and multi-disciplinary consensus for managing HK. This manuscript illustrates the recommendations of this expert committee. The panel recommends new evidenced K binders like Sodium Zirconium Cyclosilicate (SZC) and patiromer to help manage HK in cardiorenal patients as stated by different international guidelines. In emergency settings, SZC can have a role in managing acute HK; however, it should be used in addition to other drugs like insulin and glucose. Local research studies on the utilization of these novel K binders are highly recommended. The utilization of these novel K binders as prophylaxis should be tested first in a well-designed randomized controlled trial.