1. Narrative summary of results for efficacy and harm.

Study	Intervention	Efficacy	Adverse Effects
Gruy‐Kapral 1998	Resin‐cathartics	The serum potassium concentrations before the various treatments ranged from 3.4 to 5.7 mEq/L. None of the resin‐cathartic regiments caused a fall in average serum potassium concentrations, compared with prepreatment values.	None reported
Gutzwiller 2003	Haemodialysis with blood flow of 200, 250, 300 mL/min	Potassium removal was 53.0 ± 2.4, 63.4 ± 2.6, and 74.2 ± 3.8 mMol with blood flows of 200, 250, and 300 mL/min, respectively. Kt/V increased from 1.10 ± 0.14 to 1.22 ± 0.14 (10.9%) and finally to 1.39 ± 0.16 (26.4%), P = 0.0001, with increasing blood flow.	None reported
Mahajan 2001	Aminophylline infusion versus insulin‐dextrose infusion aminophyllin infusion versus insulin‐dextrose infusion	IV aminophylline lowered plasma potassium from 6.48 ± 0.39 mEq/L to 5.92 ± 0.40 mEq/L at 180 min (P < 0.001 versus basal) and 6.05 ± 0.53 mEq/L at 360 min (P < 0.01 versus basal). IV insulin‐dextrose lowered plasma potassium from 6.59 ± 0.31 mEq/L to 5.76 ± 0.32 mEq/L (P < 0.001 versus basal) and 5.84 ± 0.21 mEq/L (P < 0.001 versus basal). Aminophylline is effective for acute treatment of hyperkalaemia but it is less effective than insulin‐dextrose infusion.	There was one episode of hypoglycaemia in the insulin‐glucose group. No other side effects were observed.
Mandelberg 1999	1200 μg salbutamol through MDS‐1	Potassium levels rose from 5.5 mEq/L to 5.55 mEq/L after 1 min following completion of treatment and then decreased steadily. Potassium level decreased to 5.1 mEq/L by 60 min. The consistent reduction serium potassium levels started 3‐5 min following delivery of salbutamol.	The heart rate increased from 83 ± 2 at baseline to 89 ± 2 at 1 min was greatest at 95 ± 2 at 15 min after salbutamol inhalation. The heart rate declined slightly after 1 h.
McClure 1994	Salbutamol given IV versus salbutamol nebuliser	Within 30 min of the first dose, the mean plasma potassium concentration fell significantly by 0.87 and 0.61 mmol/L after IV and nebulised administration respectively. Sixty minutes after the second dose the plasma potassium was significantly reduced by a further 0.28 and 0.53 mmol/L respectively. At the end point of the study (300 min) the level of reduction in plasma potassium in the nebulised group was significantly greater than in the group receiving salbutamol IV (1.19 compared with 0.7 mmol/L).	No major side effects were observed. Of the 10 patients who received IV salbutamol 6 had mild short lasting tremor, and 1 had mild vasomotor flushing. Of the 10 patients who received nebulized salbutamol, 4 had tremor, 2 had tremor with nausea, and one had mild vasomotor flushing.
Ngugi 1997	Dextrose and insulin, versus bicarbonate, versus salbutamol versus 2 regimen combination treatments	Of the single therapeutic approaches, at 2 h, the decrease in serum potassium caused by insulin with glucose was 0.90 ± 0.45 mmol/L (P < 0.001) which was comparable to that caused by salbutamol 0.90 ± 0.56 mmol/L (P < 0.001). Amongst the 2 regimen combinations, at 2 hours the decrease caused by salbutamol and insulin with glucose of 1.18 ± 0.69 mmol/L (P < 0.001) was comparable to that of insulin with glucose and bicarbonate of 1.19 ± 0.50 mmol/L (P = 0.002).	None reported
Pancu 2003	Nebulised albuterol versus nebulised levalbuterol	Immediately after nebulisation, only levalbuterol showed a significant decrease in potassium level (P = 0.024). Serum potassium was lowered from a baseline value of 3.9 ± 0.3 mEq/L to 3.6 ± 0.5 at 30 min post‐treatment and to 3.6 ± 0.4mEq/L at 60 min post‐treatment with albuterol, and from 4.1 ± 0.3 mEq/L to 3.8 ± 0.2 at 30 min and to 3.6 ± 0.2 mEq/L at 60 min with levalbuterol. No significant difference was found when the albuterol and levalbuterol groups were compared. Levalbuterol caused fewer adverse effects.	Seven patients in the albuterol group had side effects (7 had tremor, 5 nervousness, 5 palpitations, 4 had tachycardia). The 4 patients with tachycarida had heart rates between 105 and 125 beats/min. Two patients in the levalbuterol group reported tremor. One patient in the normal saline group reported nervousness and palpitations.
Zehnder 2001	Dialysate containing 0, 1, and 2 mmol/L of potassium	Serum potassium at completion of dialysis was lower with 0K compared with 1K and 2K, achieving 2.7 ± 0.1, 3.0 ± 0.2 and 3.5 ± 0.1mmol/L (P < 0.001) respectively. The amount of potassium removed was significantly different between the 3 regimens used. Potassium removal was 117.1 ± 10.3 mmol for 0K, 80.2 ± 6.2 mmol for 1K, and 63.3 ± 5.2 mmol for 2K (P < 0.001). Potassium free dialysate removed 85% more potassium than 2K and 46% more than 1K.	None reported.
Allon 1990	IV insulin with glucose, nebulised albuterol or combination of IV insulin with glucose and nebulised albuterol	IV insulin with glucose produced a fall in plasma potassium apparent within 15 min of drug administration and persisted for at least one hour. Nebulised albuterol resulted in a decrease in plasma K within 30 min of initiating treatment. The mean decrease in plasma potassium was not different at 30, 45, or 60 min following the 2 respective treatments. The maximal decrease was 0.65 ± 0.09 and 0.66 ± 0.12 mmol/L after insulin with glucose and albuterol, respectively. The magnitude of fall in plasma potassium was greater with combined IV insulin and glucose and nebulized albuterol. the maximal decrease in mean plasma potassium concentration after insulin with glucose plus albuterol was 1.21 ± 0.19 mmol/L.	There were no statistically significant changes in blood pressure or heart rate following any of the treatments. Combined drug therapy (IV insulin with glucose and nebulised salbutamol) was associated with a increase in heart rate of 15.1 ± 6.0 beats/min at 60 min (P < 0.02).
Allon 1996	Isotonic bicarbonate, insulin and albuterol, and the above in combination with bicarbonate	IV bicarbonate did not decrease plasma potassium during 60 min of observation. IV insulin with dextrose decreased plasma potassium 0.5 mmol/L (P < 0.001) within 15 min and progressed for the duration of infusion. The magnitude of change at 60 min did not differ whether insulin was given with isotonic bicarbonate or saline (‐0.81 ± 0.15 mmol/L versus ‐0.85 ± 0.06 mmol/L; P = 0.65). Nebulised albuterol decreased plasma potassium by 0.2 mmol/L at 15 min and progressed for the duration of the infusion. The magnitude of change at 60 min did not differ whether albuterol was given with isotonic bicarbonate or saline (0.71 ± 0.16 mmol/L versus ‐0.53 ± 0.15 mmol/L; P = 0.18).	The 3 protocols that included bicarbonate administration resulted in significant increases in blood bicarbonate (+3.5 ± 0.5 mmol/L, +3.1 ± 0.5 mmol/L, and +2.2 ± 0.5 mmol/L, P < 0.005) and pH (+0.05 ± 0.01, +0.03 ± 0.01, and +0.03 ± 0.01, P < 0.01). Administration of insulin with glucose increased plasma glucose to high physiologic concentrations (P < 0.05) at all time points between 15 and 60 min. Nebulised albuterol produced a mild increase in plamsa glucose (P < 0.05) at time points between 30 and 60 min.
Allon 1989	Nebulised albuterol (10 mg or 20 mg) or placebo	Nebulised albuterol therapy resulted in a significant fall in the plasma potassium concentration within 30 min of drug administration that persisted for at least 2 hours. The maximal mean decrease in the potassium concentration was 0.62 ± 0.09 mmol/L after the 10 mg dose and 0.98 ± 0.14 mmol/L after the 20 mg dose (P < 0.001 for both comparisons). At all periods between 30 and 120 min, the decrease in the plasma potassium concentraion was significantly greater than that measured in the corresponding period of placebo administration. The potassium‐lowering effect of the 20 mg dose was greater than that of the 10 mg dose, but this difference achieved statistical significance only at 120 min.	No significant changes in blood pressure or heart rate with albuterol treatment. All patients denied palpitations, tremor, or chest pain after inhalation of albuterol. One patient had mild anxiety after a 20 mg dose of albuterol.
Allon 1995	Nebulised albuterol (20 mg) or placebo in addition to hemodialysis treatment	Plasma potassium decreased significantly 30 min after nebulised albuterol therapy compared to placebo in the pre‐dialysis period. Dialysis decreased plasma potassium in both groups, but plasma potassium in the albuterol treatment group has persistently lowered level than placebo. However, the total potassium removal is significantly less in the albuterol group.	Albuterol produced a significant increase in heart rate 30 minutes after its administration ( 79 ± 4 pretreatment, 103 ± 5 predialysis/30 min after administration, P < 0.001). Rare unifocal premature ventricular contractions were noted in 5/7 patients in the albuterol protocol and in 2/7 patients in the control protocol during the last 2 hours of dialysis. One patient with a history of paroxsymal atrial fibrillation developed asymptomatic atrial fibrillation after albuterol administration that resolved spontaneously.