Bananas are not the problem! Hyperkalaemia and CKD

NWL Kidney Care

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This podcast is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)
In our first North West London Kidney Care episode, Dr Andrew Frankel and Prof Jeremy Levy, Consultant Nephrologists at Imperial College Healthcare NHS Trust, discuss hyperkalaemia (high potassium levels), particularly in patients with chronic kidney disease (CKD). They explore when clinicians should be concerned about elevated potassium levels, the causes behind hyperkalaemia, and the best approaches to managing it in primary care. The episode aims to demystify the condition, provide clarity on when action is necessary, and offer practical tips for managing hyperkalaemia without unnecessary panic.

Key points include understanding spurious hyperkalaemia in primary care, recognising when potassium levels are truly concerning, and the role of commonly prescribed medications such as ACE inhibitors and angiotensin receptor blockers. The doctors also discuss treatment options like potassium binders and diuretics, emphasising the importance of maintaining heart and kidney-protective medications where possible. The episode also touches on the role of diet in managing potassium levels, clarifying misconceptions about potassium-rich foods and their impact.

Key Takeaways:

Spurious Hyperkalaemia: Often caused by delayed blood sample processing in primary care.

When to Act: Potassium levels above 6.5 mmol/L warrant urgent action. Levels between 5.5-6.5 mmol/L require follow-up but are not emergencies.

Medications: Certain medications, especially ACE inhibitors, ARBs, and mineralocorticoid receptor antagonists, can cause high potassium but are essential for heart and kidney health. New potassium binders, such as Lokelma and Veltassa, can help manage potassium without discontinuing these vital drugs.

Dietary Considerations: Bananas are not the only source of potassium. Many fruits and vegetables contain high levels, but stopping their consumption is not advisable. A balanced approach to diet is key.

Educational Resources: Potassium education sheets are available on the North West London CKD site.

This episode is a practical guide for primary care clinicians on managing potassium levels in CKD patients and balancing treatment urgency with patient well-being.
We hope you enjoy this episode.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)
Renal association: Management of hyperkalaemia in the community (algorithm) APPENDIX 5 - HYPERKALAEMIA ALGORITHM IN COMMUNITY.pdf (ukkidney.org)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.
Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Capitoli

1. Bananas are not the problem! Hyperkalaemia and CKD (00:00:00)

2. What do we mean by hyperkalemia, and when should we be worried about it? (00:01:10)

3. What are the common reasons for higher serum potassium levels in patients? (00:04:42)

4. How do you manage hyperkalemia from a primary care perspective, and what is the timeline for intervention? (00:06:41)

5. What changes have you made in dietary management for patients, particularly regarding foods like cherries? (00:14:37)