Introduction: Patients with
cardiovascular diseases (CVD) are at increased risk of
hyperkalemia, particularly when treated with
renin-
angiotensin-
aldosterone inhibitors (RAASIs). Because the occurrence or fear of
hyperkalemia, RAASIs are frequently down-titrated or discontinued in patients with CVD, with consequent worse outcomes than patients who remain on maximum doses.Areas covered: This article reviews
potassium homeostasis, epidemiology, risk factors, and outcomes of
hyperkalemia, and efficacy and safety of the drugs used for acute and chronic treatment of
hyperkalemia. A literature search was carried out using the PubMed and guidelines for the management of
hyperkalemia.Expert opinion: The
emergency treatment of
hyperkalemia is not supported by high-quality evidence and clinical trials did not report
drug effects on clinical outcomes. Two
potassium binders,
patiromer and
sodium zirconium cyclosilicate, represent a new approach in the treatment of chronic
hyperkalemia as they may allow the titration and maintenance of guidelines-recommended doses of RAASIs in patients with CVD who otherwise would not tolerate them due to the risk of
hyperkalemia.Further studies are needed to evaluate the safety and efficacy of
drug therapy and support the development of guidelines for acute and chronic
hyperkalemia.