Clinical significance of hyperkalemia and its implications for prescribing in nephrology outpatients

In this study, 503 patients who presented with hyperkalemia at least once between 2018 and 2024 at the Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Trakya University, were evaluated. Demographic, clinical, and biochemical data, as well as prescription modification status, and the use of potassium-binding (PB) and potassium-increasing (PY) medications were comprehensively analyzed. The mean age of the patients included in the study was 64.96 years, with a nearly equal distribution of males and females. Hypertension, diabetes mellitus, and coronary artery disease were identified as the most common comorbidities. During hyperkalemic admissions, significant increases were observed in urea and creatinine levels, while eGFR values declined, and potassium levels markedly rose compared to pre-admission levels. No significant differences were found in most biochemical parameters between patients using PY medications and those who did not. However, magnesium and urine pH levels were higher, and AST and uric acid levels were lower in the group not using PY drugs. Rising potassium levels were associated with increases in urea and creatinine, while decreases were observed in eGFR, hemoglobin, pH, and bicarbonate levels. Differences were detected in potassium and creatinine levels according to the types of prescription modifications. Notably, the "discontinued + PB added" group had the highest potassium levels. Creatinine levels were highest in the "no prescription change + PB added" group. While creatinine levels tended to increase over time in both groups with and without prescription changes, this increase did not show significant differences between groups. No significant differences were observed in biochemical parameters between patients whose discontinued medications were restarted and those whose medications were not restarted. However, decisions not to restart therapy were more frequent among older patients and those with more impaired renal function. No significant differences were found in biochemical parameters between patients who restarted therapy with PB and those who restarted therapy without PB. The findings of this study indicate that hyperkalemia represents a complex clinical scenario associated with renal dysfunction and comorbidities. Potassium-binding treatments are generally preferred in patients with more severe hyperkalemia and renal impairment, and prescription modifications appear to have limited impact on biochemical parameters overall.