HYPERKALEMIA IN CLINICAL PRACTICE: CURRENT APPROACHES, UNRESOLVED ISSUES AND TREATMENT STRATEGIES

Abstract

In the presented review work, an analysis of modern approaches to the management of patients with hyperkalemia is carried out, a condition that in recent years has ceased to be considered exclusively as an acute threat to heart rhythm and has acquired the status of a chronic factor limiting life-saving therapy. Based on data from 38 literature sources, including randomized clinical trials, meta-analyses, and prospective registries, it has been shown that the prevalence of hyperkalemia among patients with chronic kidney disease and heart failure reaches 35–40% when renin-angiotensin-aldosterone system blockers are taken concomitantly. A fundamental contradiction between the need to use these drugs and the risk of electrolyte disorders has been revealed. Particular attention is paid to the comparative characteristics of traditional methods of emergency correction and new potassium-binding agents (cyclosilicate zirconium, patiromer), which demonstrate the possibility of stable maintenance of normokalemia in 80–90% of patients without discontinuation of basic therapy. The article proposes an original scheme of risk stratification, as well as presents statistical data confirming the economic and clinical feasibility of introducing a personalized approach.