Management of hyperkalemia: Expert consensus from Kuwait – a Modified Delphi Approach

Ali AlSahow,1 Bassam Bulbanat,2 Bassam Alhelal,3 Khaldoun Alhumoud,4 Ahmad Alkharaza,5 Torki Alotaibi,6 Heba Alrajab,7 Anas Alyousef,8 Fatimah Hadi9 1Nephrology division, Jahra Hospital, Al Jahra, Kuwait; 2Cardiac Center, Amiri Hospital, Kuwait City, Kuwait; 3Nephrology Division, Adan Hospital, Hadiya, Kuwait; 4Al salam International Hospital, Kuwait City, Kuwait; 5Cardiology Division, Adan Hospital, Hadiya, Kuwait; 6Hamad AlEssa Transplant Center, Ibn Sina Hospital, Kuwait City, Kuwait; 7Nephrology Division, Farwaniya Hospital, Sabah Al Nasser, Kuwait; 8Nephrology Division, Amiri Hospital, Kuwait City, Kuwait; 9Cardiology Division, Chest Diseases Hospital, Kuwait City, KuwaitCorrespondence: Ali AlSahow, Nephrology Division, Department of Medicine, Jahra Hospital, Bishr Bin Awana, Jahra, 00004, Kuwait, Email [email protected]: Hyperkalemia is common in heart failure (HF) patients on renin angiotensin aldosterone inhibitors (RAASi), in chronic kidney disease (CKD), and in hemodialysis, and it negatively impacts their management. New potassium binders, such as sodium zirconium cyclosilicate (SZC), are effective in management of acute and chronic hyperkalemia. However, guidelines inconsistencies and lack of standardized treatment protocols are hindering proper and wider use of such agents. Therefore, an expert panel from Kuwait developed a consensus statement to address hyperkalemia management in acute settings, in HF, in CKD, and in hemodialysis.Methods: A three-step modified Delphi method was adopted to develop the present consensus, which consisted of two rounds of voting and in-between a virtual meeting. Twelve experts from Kuwait participated in this consensus. Statements were developed and shared with experts for voting. A meeting was held to discuss statements that did not reach consensus at the first round and then the remaining statements were shared for final voting.Results: The consensus consists of 44 statements involving an introduction to and the management of hyperkalemia in acute settings, HF, CKD, and hemodialysis. Thirty-six statements approved unanimously in the first vote. In the second vote, four statements were removed and four were approved after editing.Conclusion: Hyperkalemia management lacks standardized definitions, treatment thresholds and consistent guidelines and laboratory practices. This consensus is in response to lack of standardized treatment in the Arabian Gulf, and it aims to establish guidance on hyperkalemia management for healthcare practitioners in Kuwait and highlight future needs.Keywords: chronic kidney disease, heart failure, hemodialysis, hyperkalemia, potassium binders