# Strategies for hyperkalemia management in dialysis patients: A systematic review

## TL;DR

This paper reviews strategies to manage high potassium levels in dialysis patients, focusing on new drugs, dietary approaches, and monitoring.

## Contribution

The study evaluates novel therapies like sodium zirconium cyclosilicate and updated dietary guidelines for hyperkalemia in dialysis patients.

## Key findings

- New therapies like SZC and patiromer effectively maintain safe potassium levels in dialysis patients.
- Potassium binding packs are promising in acute and resource-limited settings.
- Strict dietary potassium restrictions may not be necessary, especially for plant-based foods.

## Abstract

Hyperkalemia is a potentially life-threatening electrolyte disorder, especially in patients with chronic kidney disease and those undergoing dialysis. Its management is complex due to the need to balance potassium control with overall patient stability.

The aim of this systematic review is to evaluate current therapeutic strategies for hyperkalemia in dialysis patients, including diuretics, ion-exchange resins, and newer agents such as sodium zirconium cyclosilicate (SZC).

A systematic search was conducted in Scopus and Web of Science, applying filters for language, recency (≤5 years), and journal quality. After removing duplicates and irrelevant records, 11 high-quality studies were included.

New therapies like SZC and patiromer demonstrated efficacy in maintaining safe potassium levels. The potassium binding pack showed promise in acute and resource-limited settings. Evidence challenges strict dietary potassium restrictions, especially regarding plant-based foods, and highlights the importance of individualized nutritional plans. Continuous potassium monitoring is essential to preserve residual kidney function.

Hyperkalemia management in dialysis patients benefits from an integrated approach combining pharmacologic treatment, tailored nutrition, and close monitoring. Novel interventions and evolving dietary guidelines may improve safety, effectiveness, and quality of life in this vulnerable population.