Table 1.

Co-determinants of hyperkalemia in CKD

Increased K release from cells

Pseudohyperkalemia

Metabolic acidosis

Absolute or relative insulin deficiency (hyperglycemia), hyperosmolality

Increased tissue catabolism, gastrointestinal bleeding

Non-selective beta blockers and other drugs known to induce hyperkalemia

Reduced urinary K excretion

K intake “not adjusted” to GFR level

Reduced aldosterone secretion/effect (diabetes mellitus, RAASIs, K-sparing diuretics)

Reduced distal sodium delivery (heart failure, all-cause oliguria)

Reduced bowel K excretion

Constipation, ileus

CKD chronic kidney disease; GFR glomerular filtration rate; K potassium, RAASIs renin-angiotensin-aldosterone system inhibitors