Table 3.

Approach to minimize risk of hyperkalemia when ingesting high potassium diet

Approach
Accurately assess level of kidney function to better define risk
Discontinue drugs that interfere in kidney potassium secretion, inquire about herbal preparations, and discontinue nonsteroidal anti-inflammatory drugs to include selective cyclooxygenase 2 inhibitors
Avoid potassium-containing salt substitutes
Thiazide or loop diuretics (loop diuretics necessary when eGFR <30 ml/min)
Sodium bicarbonate to correct metabolic acidosis in patients with CKD
Consider long-term use of binding drugs (patiromer or sodium zirconium cyclosilicate)
If patient is receiving or starting a RAAS inhibitor (ACEi, ARB, mineralocorticoid blocker)
 Measure potassium 1 week after initiation of such therapy or after increasing dose of drug
 For increases in potassium up to 5.5 mEq/L, decrease dose of drug; or if taking some combination of ACEi, ARB, or mineralocorticoid blocker, discontinue one and recheck potassium or consider long-term use of potassium-binding drug
 The dose of spironolactone should not exceed 25 mg daily when used with an ACEi or ARB, this combination of drugs should be avoided with GFR <30 ml/min
 For potassium ≥5.6 mEq/L despite above steps, consider long-term use of binding drugs to enable use of RAAS inhibitor if clinically indicated
  • ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; RAAS, renin-angiotensin-aldosterone system.