Cardiovascular disease treatment and hyperkalemia: A report of three cases
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- Published online on: July 18, 2025 https://doi.org/10.3892/mi.2025.253
- Article Number: 54
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Copyright : © Paydaş et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
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Abstract
Renin‑angiotensin‑aldosterone system inhibitors (RAASi) are primarily used for the treatment of hypertension and diabetic/non‑diabetic reno‑cardiovascular diseases. The present study describes the cases of 3 patients with hyperkalemia that occurred during RAASi therapy and describes the therapeutic approach used for this serious complication. The clinical/laboratory findings of hospitalized patients with hyperkalemia within a short time period (within 30 days) and treatment were recorded. Acute hyperkalemia developed due to angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) and spironolactone in 3 patients, whose cases are reported herein. Insulin glucose infusion (IGI) + salbutamol + potassium binders were used for the treatment of severe hyperkalemia. Acute kidney injury (AKI) regressed in all patients. Hyperkalemia was corrected within 6 h in 1 patient who was treated with sodium zirconium cyclosilicate in addition to IGI. On the whole, the present study demonstrates that hyperkalemia may be symptomatic/asymptomatic and may develop during the earlier or later period of RAASi therapy for cardiovascular‑renal disease, particularly in older patients. AKI improved with the correction of hyperkalemia and the discontinuation of ACEi/ARB and spironolactone. Sodium zirconium cyclosilicate may be the preferred treatment in emergency cases of hyperkalemia due to its rapid effects. On the other hand, sodium glucose co‑transporter 2 inhibitors and non‑steroidal mineralocorticoid receptor antagonists may also be used to avoid the development of hyperkalemia in patients undergoing RAASi therapy.
