Executive Summary of the Malaysian Consensus on the Management of Acute and Persistent Hyperkalaemia: A Multidisciplinary Approach

Malaysian Consensus on Managing Hyperkalaemia
Vol. 20 No. 2 : 2025 (693-709)

Lim Soo Kun Lim Soo Kun
Mohd Rahal Yusoff Mohd Rahal Yusoff
Shaik Farid Abdull Wahab Shaik Farid Abdull Wahab
Sunita Bavanandan Sunita Bavanandan
Chew Soon Ping David Chew Soon Ping David
Ching Chen Hua   Ching Chen Hua
Siti Suhaila Hamzah Siti Suhaila Hamzah
Paranthaman Kaneson Paranthaman Kaneson
Liew Houng Bang Liew Houng Bang
Prasad Menon Prasad Menon
Azmee Mohd Ghazi Azmee Mohd Ghazi
Tan Li Ping Tan Li Ping

Abstract
Hyperkalaemia (HyperK+) is a potentially life-threatening condition that poses significant challenges in both acute and chronic care, especially for patients with chronic kidney disease, heart failure and diabetes mellitus. While renin-angiotensin-aldosterone system inhibitors (RAASi) are guideline-directed medical therapy known for their cardiorenal benefits, concerns about the increased risk of hyperK+ associated with these medications have hindered their optimal use. Despite these challenges, ambiguity remains regarding the management of hyperK+, highlighting the need for a standardised approach. This Malaysian consensus provides evidence-based guidelines for managing acute and persistent hyperK+ tailored to the local healthcare context.
Keywords : Cardiorenal syndrome; emergency medicine; hyperkalaemia; sodium zirconium cyclosilicate,
Abstrak
Tahap kalium yang tinggi (hyperkalaemia; hyperK+) adalah keadaan yang berpotensi mengancam nyawa. Ia berpotensi menimbulkan cabaran besar semasa pengurusan hyperK+ akut dan jangka panjang, terutamanya bagi pesakit dengan penyakit buah pinggang kronik, kegagalan jantung dan kencing manis (diabetes melitus). Meskipun ubat perencat sistem renin-angiotensin-aldosteron merupakan terapi perubatan yang disarankan dalam garis panduan untuk pengamalan klinikal dan terbukti membawa manfaat kardiorenal, kebimbangan mengenai peningkatan risiko hyperK+ disebabkan ubat-ubatan ini telah menjejaskan penggunaan optimumnya. Walaupun cabaran ini wujud, pengurusan hyperK+ masih kurang jelas dan menimbulkan keperluan untuk menyeragamkan cara hyperK+ diuruskan. Penyata-penyata konsensus ini menyediakan garis panduan berasaskan bukti terkini bagi pengurusan hyperK+ akut dan kronik yang disesuaikan dengan konteks penjagaan kesihatan tempatan.
Kata Kunci : Hyperkalaemia; natrium zirkonium siklasilikat; perubatan kecemasan; sindrom kardiorenal,

Correspondance Address
Lim Soo Kun. Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Wilayah Persekutuan, Malaysia. Tel: +603 79492555 Email: limsk@ummc.edu.my


All K+ levels are in mmol/L. *RAAS-i = ACE-i/ARB, ARNI and MRA. [ACE-i: angiotensin-converting enzyme inhibitor; AKI: acute kidney injury; ARB: angiotensin II receptor blocker; ARNI: angiotensin receptor-neprilysin inhibitor; CKD: chronic kidney disease; CPS: calcium polystyrene sulfonate; ECG: electrocardiogram; ED: emergency department; HF: heart failure; K+: potassium; MRA: mineralocorticoid receptor antagonist; NSAID: non-steroidal anti-inflammatory drug; PO: orally; TDS: three times daily; RAAS-i: reni