Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system
Abstract
Hyperkalemia can develop as a result of treatment with angiotensin-converting–enzyme inhibitors or angiotensin-receptor blockers. This side effect is most common in patients with risk factors such as diabetes mellitus, heart failure, chronic kidney disease, or advanced age. This review explains the pathophysiology and offers clinical guidance for management.
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Risk factors for the development of hyperkalemia with the use of drugs that inhibit the RAS include CKD, diabetes, decompensated congestive heart failure, volume depletion, advanced age, and use of concomitant medications that interfere with kidney potassium excretion.
“Risk factors for the development of hyperkalemia with the use of drugs that inhibit the RAS included CKD, diabetes, decompensated congestive heart failure, volume depletion, advanced age, and use of concomitant medications that interfere with kidney potassium excretion. 71”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [71]
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- Authors
- Palmer, B. F.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Palmer, Biff F.
- ORCID
- Palmer, Biff F.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2004-08-05
- Volume
- 351
- Issue
- 6
- Pages
- 585-592
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2093767567
- Semantic Scholar
- 58d9c67c801fe4f1082d485f5f4497ed175693d9
- Cited by
- 640
- References
- 59
- Citations by year
- 2026: 19 · 2025: 29 · 2024: 28 · 2023: 28 · 2022: 24 · 2021: 23 · 2020: 34 · 2019: 28 · 2018: 35 · 2017: 42 · 2016: 31 · 2015: 28 · 2014: 30 · 2013: 21 · 2012: 37
- FWCI
- 4.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Genetics › Coagulation, Bradykinin, Polyphosphates, and Angioedema
- Keywords
- hyperkalemia, renin-angiotensin-aldosterone system inhibitors, ACE inhibitors, angiotensin receptor blockers, drug-induced hyperkalemia, pathophysiology, diabetes mellitus, heart failure, chronic kidney disease, elderly patients, hyperkalemia management
- MeSH terms
- Aldosterone, Angiotensin-Converting Enzyme Inhibitors, Humans, Hyperkalemia, Kidney, Potassium, Renin-Angiotensin System, Risk Factors, Sodium, Angiotensin Receptor Antagonists
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