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Pharmacological interventions for the acute management of
hyperkalaemia in adults (Review)

  Batterink J, Cessford TA, Taylor RAI  

  Batterink J, Cessford TA, Taylor RAI.  

Pharmacological interventions for the acute management of hyperkalaemia in adults.
Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD010344.
DOI: 10.1002/14651858.CD010344.pub2.

  www.cochranelibrary.com  

 
Pharmacological interventions for the acute management of hyperkalaemia in adults (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 Cochrane Trusted evidence.
Informed decisions.
 
 
Library Better health. Cochrane Database of Systematic Reviews

[Intervention Review]

Pharmacological interventions for the acute management of

hyperkalaemia in adults

Josh Batterink1, Tara A Cessford2, Robert AI Taylor1

1Pharmacy, Providence Health Care, Vancouver, Canada. 2Internal Medicine, University of British Columbia, Vancouver, Canada

Contact address: Josh Batterink, Pharmacy, Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
batterinkj@gmail.com.

Editorial group: Cochrane Kidney and Transplant Group.

Publication status and date: Edited (no change to conclusions), published in Issue 10, 2015.

Citation: Batterink J, Cessford TA, Taylor RAI. Pharmacological interventions for the acute management of hyperkalaemia in adults.
Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD010344. DOI: 10.1002/14651858.CD010344.pub2.

Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT

Background
Hyperkalaemia is a potentially life-threatening electrolyte disturbance which may lead to cardiac arrhythmias and death. Renal
replacement therapy is known to be effective in treating hyperkalaemia, but safe and effective pharmacological interventions are needed
to prevent dialysis or avoid the complications of hyperkalaemia until dialysis is performed.

Objectives
This review looked at the benefits and harms of pharmacological treatments used in the acute management of hyperkalaemia in adults.
This review evaluated the therapies that reduce serum potassium as well as those that prevent complications of hyperkalaemia.

Search methods
We searched Cochrane Kidney and Transplant's Specialised Register to 18 August 2015 through contact with the Trials' Search Co-ordinator
using search terms relevant to this review.

Selection criteria
All randomised controlled trials (RCTs) and quasi-RCTs looking at any pharmacological intervention for the acute management of
hyperkalaemia in adults were included in this review. Non-standard study designs such as cross-over studies were also included. Eligible
studies enrolled adults (aged 18 years and over) with hyperkalaemia, defined as serum potassium concentration ≥ 4.9 mmol/L, to receive
pharmacological therapy to reduce serum potassium or to prevent arrhythmias. Patients with artificially induced hyperkalaemia were
excluded from this review.

Data collection and analysis

All three authors screened titles and abstracts, and data extraction and risk of bias assessment was performed independently by at
least two authors. Studies reported in non-English language journals were translated before assessment. Authors were contacted when
information about results or study methodology was missing from the original publication. Although we planned to group all studies of
a particular pharmacological therapy regardless of administration route or dose for analysis, we were unable to conduct meta-analyses
because of the small numbers of studies evaluating any given treatment. For continuous data we reported mean difference (MD) and 95%
confidence intervals (CI).

Pharmacological interventions for the acute management of hyperkalaemia in adults (Review) 1

Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 Cochrane Trusted evidence.
Informed decisions.
 
 
Library Better health. Cochrane Database of Systematic Reviews

Main results
We included seven studies (241 participants) in this review. Meta-analysis of these seven included studies was not possible due to
heterogeneity of the treatments and because many of the studies did not provide sufficient statistical information with their results.
Allocation and blinding methodology was poorly described in most studies.

No study evaluated the efficacy of pharmacological interventions for preventing clinically relevant outcomes such as mortality and cardiac
arrhythmias; however there is evidence that several commonly used therapies effectively reduce serum potassium levels. Salbutamol
administered via either nebulizer or metered-dose inhaler (MDI) significantly reduced serum potassium compared with placebo. The peak
effect of 10 mg nebulised salbutamol was seen at 120 minutes (MD -1.29 mmol/L, 95% CI -1.64 to -0.94) and at 90 minutes for 20 mg
nebulised salbutamol (1 study: MD -1.18 mmol/L, 95% CI -1.54 to -0.82). One study reported 1.2 mg salbutamol via MDI 1.2 mg produced
a significant decrease in serum potassium beginning at 10 minutes (MD -0.20 mmol/L, P < 0.05) and a maximal decrease at 60 minutes
(MD -0.34 mmol/L, P < 0.0001). Intravenous (IV) and nebulised salbutamol produced comparable effects (2 studies). When compared to
other interventions, salbutamol had similar effect to insulin-dextrose (2 studies) but was more effective than bicarbonate at 60 minutes
(MD -0.46 mmol/L, 95% CI -0.82 to -0.10; 1 study). Insulin-dextrose was more effective than IV bicarbonate (1 study) and aminophylline (1
study). Insulin-dextrose, bicarbonate and aminophylline were not studied in any placebo-controlled studies. None of the included studies
evaluated the effect of IV calcium or potassium binding resins in the treatment of hyperkalaemia.

Authors' conclusions
Evidence for the acute pharmacological management of hyperkalaemia is limited, with no clinical studies demonstrating a reduction in
adverse patient outcomes. Of the studied agents, salbutamol via any route and IV insulin-dextrose appear to be most effective at reducing
serum potassium. There is limited evidence to support the use of other interventions, such as IV sodium bicarbonate or aminophylline.
The effectiveness of potassium binding resins and IV calcium salts has not been tested in RCTs and requires further study before firm
recommendations for clinical practice can be made.

PLAIN LANGUAGE SUMMARY

Pharmacological interventions for the acute management of hyperkalaemia in adults

Hyperkalaemia is a serious medical problem that may cause heart problems or death. There are several treatments that can be used to
treat hyperkalaemia but the risks and benefits of each intervention are poorly understood. We performed this review to determine whether
treatments for hyperkalaemia are effective and safe

We searched for all studies that tested whether therapies were effective and safe at treating high potassium published up to 18 August
2015. We found seven studies that investigated drug therapies for treating hyperkalaemia in adults which together included results from
241 participants. Most studies tested the therapies in male and female adults with kidney problems who were medically stable. We did not
find any studies that looked at the serious medical complications of high potassium such as death.

We found that salbutamol and insulin-dextrose were effective in reducing potassium levels in the blood. We found that salbutamol was
effective whether it was given intravenously or by nebuliser. Those treatments appeared to be more effective than other treatments such
as sodium bicarbonate and aminophylline. None of the studies found any serious adverse reactions to the medications.

Overall, the quality of evidence was assessed as poor because the studies were small in size and the methods for how the studies were
performed were not well described. None of the studies looked at the serious problems caused by hyperkalaemia and this limited the
strength of the evidence.

Pharmacological interventions for the acute management of hyperkalaemia in adults (Review) 2

Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.