Interdisciplinary recommendations for recurrent hyperkalaemia: insights from the GUARDIAN-HK European Steering Committee
European interdisciplinary steering comm… · 2025 · Europe
Source and licence
- Authors
- Gianluigi Savarese, María Jesús Izquierdo, Clara Bonanad et al.
- Title
- Interdisciplinary recommendations for recurrent hyperkalaemia: insights from the GUARDIAN-HK European Steering Committee
- Journal
- European Heart Journal. Cardiovascular Pharmacotherapy, 2025
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12582656
Licence statement of the original publication
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Methods
- Recommendation 1Reducing the risk of recurrence should be standard practice in the management of HK, regardless of the setting
- Recommendation 2It is the responsibility of all HCPs to evaluate and address the risk of recurrence of HK at every clinical encounter
- Recommendation 3Every patient encounter should be an opportunity to optimize RAASi therapy, even in the context of an HK event
- Recommendation 4Long-term conditions, such as kidney disease, CVD and T2D, and an associated reliance on disease-modifying therapy that interferes with potassium homeostasis should be considered irreversible factors associated with HK
- Recommendation 5In patients at risk of HK, a risk stratification tool for HK recurrence is required and could guide management
- Recommendation 6The initial aim of management of HK should be to normalize serum potassium levels as needed and correct reversible precipitating factors
- Recommendation 7If there is no reversible factor, treatment to prevent recurrence of HK should be initiated
- Recommendation 8The risk of recurrence of HK should be reduced without discontinuing or down-titrating disease-modifying therapy such as RAASi
- Recommendation 9Unless the cause of acute HK can be reversed, treatment for recurrent HK is likely to be indefinite
- Recommendation 10Following normalisation using a potassium binder, additional monitoring of serum potassium levels beyond that for routine comorbidities should not be necessary
Abstract
Recurrent hyperkalaemia (HK) is associated with increased morbidity and mortality, and is common among patients with cardiorenal disease. Many of these patients require renin–angiotensin–aldosterone system inhibitor (RAASi) therapies that further enhance the risk of HK. Every acute HK episode constitutes an opportunity to treat and prevent recurrent HK. This report aims to support multidisciplinary team efforts in managing patients who may be affected by recurrent HK. A panel of nine European experts in the management of HK (four nephrologists, four cardiologists, one internist) reviewed existing guidance and evidence on the diagnosis and management of HK at a face-to-face (26th September 2023) and two virtual meetings (24th January and 14th March 2024). The panel developed 10 consensus recommendations and a management algorithm across three domains: duty of care, identifying patients at risk of HK recurrence and managing the risk of HK recurrence. Early identification and management of those at risk of recurrent HK will improve clinical outcomes but requires an interdisciplinary, co-ordinated approach. Disease-modifying therapies such as RAASi should no longer be considered reversible causes of HK, and efforts should be taken to up-titrate these to guideline-directed target doses even in the setting of an acute HK event. Every acute HK episode constitutes an opportunity to treat and prevent recurrent HK, contributing to long-term clinical benefits. The recommendations, intentionally broad in scope, complement existing management guidelines and plans, fostering a collective responsibility among healthcare professionals managing patients with HK.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Recommendations
- Duty of care
- Identifying patients at risk of HK recurrence
- Managing the risk of HK recurrence
- Discussion
- Conclusions
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