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Pharmacological interventions for the acute treatment of hyperkalaemia: A systematic review and meta-analysis

MK. Jessen, LW. Andersen, J. Djakow, NK. Chong, N. Stankovic, C. Staehr, L. Vammen, AH. Petersen, CM. Johannsen, MA. Eggertsen, SØ. Mortensen, M. Høybye, C. Nørholt, MJ. Holmberg, A. Granfeldt, International Liaison Committee on Resuscitation...

. 2025 ; 208 (-) : 110489. [pub] 20250104

Language English Country Ireland

Document type Systematic Review, Journal Article, Meta-Analysis, Review

Persistent link   https://www.medvik.cz/link/bmc25009705

BACKGROUND: Hyperkalaemia is a life-threatening electrolyte disturbance and also a potential cause of cardiac arrest. The objective was to assess the effects of acute pharmacological interventions for the treatment of hyperkalaemia in patients with and without cardiac arrest. METHODS: The review was reported according to PRISMA guidelines and registered on PROSPERO (CRD42023440553). We searched OVID Medline, EMBASE, and CENTRAL on September 9, 2024 for randomized trials, non-randomized trials, observational studies, and experimental animal studies. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. Outcomes included potassium levels, ECG findings, and clinical outcomes. Certainty of evidence was evaluated using GRADE. RESULTS: A total of 101 studies were included, with two studies including patients with cardiac arrest. In meta-analyses including adult patients without cardiac arrest, treated with insulin in combination with glucose, inhaled salbutamol, intravenous salbutamol dissolved in glucose, or a combination, the average reduction in potassium was between 0.7 and 1.2 mmol/l (very low to low certainty of evidence). The use of bicarbonate had no effect on potassium levels (very low certainty of evidence). In neonatal and paediatric populations, inhaled salbutamol and intravenous salbutamol reduced the average potassium between 0.9 and 1.0 mmol/l (very low to low certainty of evidence). There was no evidence to support a clinical beneficial effect of calcium for treatment of hyperkalemia. CONCLUSIONS: Evidence supports treatment with insulin in combination with glucose, inhaled or intravenous sal-butamol, or the combination. No evidence supporting a clinical effect of calcium or bicarbonate for hyperkalaemia was identified.

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$a Jessen, Marie Kristine $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Research Centre for Emergency Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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$a Pharmacological interventions for the acute treatment of hyperkalaemia: A systematic review and meta-analysis / $c MK. Jessen, LW. Andersen, J. Djakow, NK. Chong, N. Stankovic, C. Staehr, L. Vammen, AH. Petersen, CM. Johannsen, MA. Eggertsen, SØ. Mortensen, M. Høybye, C. Nørholt, MJ. Holmberg, A. Granfeldt, International Liaison Committee on Resuscitation (ILCOR) Advanced Paediatric Life Support Task Forces
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$a BACKGROUND: Hyperkalaemia is a life-threatening electrolyte disturbance and also a potential cause of cardiac arrest. The objective was to assess the effects of acute pharmacological interventions for the treatment of hyperkalaemia in patients with and without cardiac arrest. METHODS: The review was reported according to PRISMA guidelines and registered on PROSPERO (CRD42023440553). We searched OVID Medline, EMBASE, and CENTRAL on September 9, 2024 for randomized trials, non-randomized trials, observational studies, and experimental animal studies. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. Outcomes included potassium levels, ECG findings, and clinical outcomes. Certainty of evidence was evaluated using GRADE. RESULTS: A total of 101 studies were included, with two studies including patients with cardiac arrest. In meta-analyses including adult patients without cardiac arrest, treated with insulin in combination with glucose, inhaled salbutamol, intravenous salbutamol dissolved in glucose, or a combination, the average reduction in potassium was between 0.7 and 1.2 mmol/l (very low to low certainty of evidence). The use of bicarbonate had no effect on potassium levels (very low certainty of evidence). In neonatal and paediatric populations, inhaled salbutamol and intravenous salbutamol reduced the average potassium between 0.9 and 1.0 mmol/l (very low to low certainty of evidence). There was no evidence to support a clinical beneficial effect of calcium for treatment of hyperkalemia. CONCLUSIONS: Evidence supports treatment with insulin in combination with glucose, inhaled or intravenous sal-butamol, or the combination. No evidence supporting a clinical effect of calcium or bicarbonate for hyperkalaemia was identified.
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$a Andersen, Lars Wiuff $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
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$a Djakow, Jana $u Paediatric Intensive Care Unit, NH Hospital Inc., Hořovice, Czech Republic; Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic; Department of Simulation Medicine, Medical Faculty of Masaryk University, Brno, Czech Republic
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$a Chong, Ng Kee $u KK Women's and Children's Hospital, Singapore
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$a Stankovic, Nikola $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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$a Staehr, Christian $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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$a Vammen, Lauge $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark
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$a Petersen, Alberthe Hjort $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
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$a Johannsen, Cecilie Munch $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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$a Eggertsen, Mark Andreas $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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$a Mortensen, Signe Østergaard $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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$a Høybye, Maria $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Gastrointestinal Surgery, Hvidovre Hospital, Copenhagen, Denmark
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$a Nørholt, Casper $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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$a Holmberg, Mathias Johan $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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$a Granfeldt, Asger $u Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: granfeldt@clin.au.dk
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