Overview of Hyperkalemia
The body needs a balance of certain minerals and electrolytes in order to function correctly.(1) Potassium is an essential mineral and electrolyte that is required by the body for ensuring normal nerve and muscle function, including the heart muscle.(2) While we tend to get most of the potassium we need from our diet itself, sometimes it may happen that we end up having too much potassium in the bloodstream.(3) Having high potassium levels in the blood can lead to many heart conditions, including arrhythmias, which is a condition that causes the heart to beat irregularly. Such types of cardiac changes due to high potassium can lead to death if left untreated.(4,5)
A high potassium level in the blood is known as hyperkalemia. While hyperkalemia can affect anybody, there are some people who are at a greater risk of developing this condition as compared to others.(6,7)
Some of the main risk factors for hyperkalemia include:
- Underlying medical conditions
- Certain medications
Here’s everything you need to know about the risk factors for hyperkalemia.
Diet as a Risk Factor for Hyperkalemia
Your diet can be one of the biggest risk factors for developing hyperkalemia. You should adjust your diet by opting to have low-potassium foods and avoiding foods that are high in potassium. Your doctor is going to ask you about your diet and also recommend that you restrict or avoid the intake of certain foods to manage your blood potassium levels. They may also recommend that you visit a dietitian to come up with a meal plan that limits the consumption of high potassium foods.(8)
Many people think they do not need a dietitian to tell them what to eat, and they can themselves cut out high potassium foods from their diet. However, eating too little potassium can also be just as harmful, which is why it is essential to find a healthy balance that is just right for you.(9)
Some of the examples of high potassium foods that you should avoid or limit include:
- Fruits like bananas, nectarines, oranges, kiwi, honeydew, cantaloupe, prunes, raisins, and any other dried fruit.
- Vegetables such as potatoes, tomatoes, avocados, Brussels sprouts, pumpkin, cooked spinach, and broccoli.
- Other foods such as nuts, seeds, chocolate, milk, yogurt, peanut butter, and bran products.
On the other hand, you should be including low potassium foods like:(10)
- Fruits like berries (cranberries, blueberries, strawberries, raspberries), apples, grapes, plums, pineapple, watermelon, and others.
- Vegetables such as cabbage, asparagus, cucumber, cauliflower, iceberg lettuce, radishes, eggplant, and onions.
- Other foods like noodles, rice, pasta, bread that is not whole grain, cookies that don’t include chocolate and nuts, and yellow cake.
It is important to note that even while having foods that are low in potassium, you will still need to watch your portion size. Nearly every food has some amount of potassium in it, and so your serving size is an essential factor to consider.
It is also possible to remove some of the potassium in high potassium foods like carrots and potatoes by leaching them. You can do this by soaking the peeled and sliced vegetables in water for at least two hours. Boiling the vegetables before consuming can also successfully pull out some of the potassium in them.(11,12)
Underlying Medical Conditions as a Risk Factor for Hyperkalemia
Your kidneys are responsible for maintaining the body’s balance of all the electrolytes, including potassium. A person is at a higher risk of having unbalanced electrolytes when the kidneys stop working properly. This means that people with underlying kidney conditions are at a greater risk of developing electrolyte disorders such as hyperkalemia.
Chronic kidney disease is one of the most common causes of hyperkalemia. In fact, the rate of hyperkalemia in people with chronic kidney disease has been said to be as high as 73%.(13)
Several other medical conditions can also increase the risk of developing hyperkalemia, such as:
- Congestive heart failure(15)
- High blood pressure(16)
- Addison’s disease, a condition that occurs when the body does not produce enough hormones(17)
Some of the less common medical conditions that cause hyperkalemia include:
- Infections such as HIV/AIDS(18)
- Burns or severe injuries that cover a large area of the body
- Muscle and cell damage because of heavy drug or alcohol use
Early treatment and managing medical conditions such as diabetes can help decrease the risk of hyperkalemia. However, if high potassium levels continue to persist, your doctor may then recommend treatments like potassium binders or diuretics.
Certain Medications as a Risk Factor for Hyperkalemia
There are many medications that are known to increase the risk of developing hyperkalemia. The most common of these are medications used for treating blood pressure and heart-related conditions.
Here are some medications that are known to cause high potassium in the body:
- Heparin, a blood thinner
- Angiotensin-converting enzyme (ACE) inhibitors(19)
- Angiotensin receptor blockers (ARBs)(20)
- Calcineurin inhibitors
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and aspirin
- Potassium dietary supplements
- Potassium-based salt substitutes
- Antibiotics like pentamidine and trimethoprim
Supplements and non-prescription drugs can also increase the risk of high blood potassium levels. This can include supplements like:
- Hawthorn berries
- Siberian ginseng
- Noni juice
Usually, people with chronic kidney disease, who are already at a high risk of developing hyperkalemia, must try to avoid taking such herbal supplements. It is also recommended that you talk to your doctor before starting any new supplements or medications.
If you are on medication for high blood pressure or heart disease and your potassium levels are going up due to these medications, your doctor will then either adjust your dose or change your medicine. It is essential that you do not stop taking any medication without consulting your doctor. It is also necessary that you follow your doctor’s advice and continue having regular checkups to observe your potassium levels.
Hyperkalemia is a condition of having high potassium levels in the bloodstream. It can cause serious health problems, including cardiovascular disease, if left untreated. There are certain risk factors that put certain people at a higher risk of developing hyperkalemia. If you are at an increased risk of developing high potassium levels, you must talk to your doctor to find out how to reduce this risk.
It is essential that you consult your doctor to discuss your risk factors, your diet, medications, and underlying medical conditions. Following a low-potassium diet, restricting intake of high-potassium foods, exercising regularly, and following your doctor’s advice will ensure that you are on the right path to reducing your risk of hyperkalemia.
- Solomon, R.J. and Cole, A.G., 1981. Importance of potassium in patients with acute myocardial infarction. Acta Medica Scandinavica, 209(S647), pp.87-93.
- Sica, D.A., Struthers, A.D., Cushman, W.C., Wood, M., Banas Jr, J.S. and Epstein, M., 2002. Importance of potassium in cardiovascular disease. The Journal of Clinical Hypertension, 4(3), pp.198-206.
- Parham, W.A., Mehdirad, A.A., Biermann, K.M. and Fredman, C.S., 2006. Hyperkalemia revisited. Texas Heart Institute Journal, 33(1), p.40.
- Juurlink, D.N., Mamdani, M.M., Lee, D.S., Kopp, A., Austin, P.C., Laupacis, A. and Redelmeier, D.A., 2004. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. New England Journal of Medicine, 351(6), pp.543-551.
- Ponce, S.P., Jennings, A.E., Madias, N.E. and Harrington, J.T., 1985. Drug-induced hyperkalemia. Medicine, 64(6), pp.357-370.
- DeFronzo, R.A., 1980. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney international, 17(1), pp.118-134.
- Evans, K.J. and Greenberg, A., 2005. Hyperkalemia: a review. Journal of Intensive Care Medicine, 20(5), pp.272-290.
- FREGLY, M.J., 1983. Estimates of sodium and potassium intake. Annals of Internal Medicine, 98(5_Part_2), pp.792-799.
- Nielsen, F., 2012. Calcium, magnesium, and potassium in food. Fertilizing Crops to Improve Human Health: a Scientific Review, p.123.
- Arbeit, M.L., Nicklas, T.A. and Berenson, G.S., 1992. Considerations of dietary sodium/potassium/energy ratios of selected foods. Journal of the American College of Nutrition, 11(2), pp.210-222.
- Picq, C., Asplanato, M., Bernillon, N., Fabre, C., Roubeix, M. and Ricort, J.M., 2014. Effects of water soaking and/or sodium polystyrene sulfonate addition on potassium content of foods. International journal of food sciences and nutrition, 65(6), pp.673-677.
- Weaver, C.M., 2013. Potassium and health. Advances in Nutrition, 4(3), pp.368S-377S.
- Kovesdy, C.P., 2017. Updates in hyperkalemia: outcomes and therapeutic strategies. Reviews in Endocrine and Metabolic Disorders, 18(1), pp.41-47.
- Uribarri, J., Oh, M.S. and Carroll, H.J., 1990. Hyperkalemia in diabetes mellitus. Journal of Diabetic Complications, 4(1), pp.3-7.
- Obialo, C.I., Ofili, E.O. and Mirza, T., 2002. Hyperkalemia in congestive heart failure patients aged 63 to 85 years with subclinical renal disease. American Journal of Cardiology, 90(6), pp.663-665.
- Khosla, N., Kalaitzidis, R. and Bakris, G.L., 2009. Predictors of hyperkalemia risk following hypertension control with aldosterone blockade. American journal of nephrology, 30(5), pp.418-424.
- Pollen, R.H. and Williams, R.H., 1960. Hyperkalemic neuromyopathy in Addison’s disease. New England Journal of Medicine, 263(6), pp.273-278.
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- Palmer, B.F., 2004. Managing hyperkalemia caused by inhibitors of the renin–angiotensin–aldosterone system. New England Journal of Medicine, 351(6), pp.585-592.
- Reardon, L.C. and Macpherson, D.S., 1998. Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors: how much should we worry?. Archives of internal medicine, 158(1), pp.26-32.