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Dtsch Med Wochenschr 2019; 144(22): 1576-1584
DOI: 10.1055/a-0762-8244
Review
© Georg Thieme Verlag KG Stuttgart · New York

Hyperkaliämie

Pathophysiologie, prognostische Bedeutung und therapeutische MöglichkeitenHyperkalemiaPathophysiology, prognostic significance and treatment options
Louisa M. S. Gerhardt
1   Medizinische Universitätsklinik, Allgemeine Innere und Notfallmedizin, Kantonsspital Aarau, Aarau, Schweiz
,
Christiane E. Angermann
2   Medizinische Klinik I und Deutsches Zentrum für Herzinsuffizienz, Universität und Universitätsklinikum Würzburg, Würzburg, Deutschland
› Author Affiliations
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Publication History

Publication Date:
28 October 2019 (online)

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Zusammenfassung

Hyperkaliämie erhöht bei stationären wie auch ambulanten Patienten das Morbiditäts- und Mortalitätsrisiko. Verursacht wird diese häufige Elektrolytstörung durch verminderte renale Kaliumelimination, vermehrte Kaliumzufuhr oder Kaliumverschiebung vom Intra- in den Extrazellularraum, wenn Ausscheidungs- oder Regulationsmechanismen zusätzlich beeinträchtigt sind. Hyperkaliämie kann zur Störung des zellulären Membranpotenzials und in der Folge zu lebensbedrohlichen Herzrhythmusstörungen führen. Ein besonders hohes Hyperkaliämie-Risiko haben herzinsuffiziente Patienten, die zudem an Niereninsuffizienz und/oder Diabetes mellitus leiden. Folgen sind oft eine nicht ausreichende Dosierung, Dosisreduktion oder Absetzen prognostisch wichtiger Herzinsuffizienzmedikamente, die eine Hyperkaliämie-Neigung verstärken (z. B. Angiotensin-Konversionsenzym-Hemmer, Angiotensin-Rezeptorblocker und Mineralokortikoidrezeptor-Antagonisten). Neue orale Kaliumbinder könnten die Therapiemöglichkeiten entscheidend erweitern.

Abstract

Hyperkalemia increases morbidity and mortalilty risk in both in- and outpatients. Common causes are decreased renal excretion, excess intake or potassium shifting from the intra- to the extracellular space in combination with reduced renal excretion or impairment of regulation. Hyperkalemia may alter the cellular transmembrane potential and cause life-threatening arrhythmias. Heart failure patients with comorbid renal insufficiency and/or diabetes mellitus are at increased risk of developing hyperkalemia, which thus constitutes a common reason for insufficient up-titration, down-titration or discontinuation of prognostically relevant heart failure medications predisposing to hyperkalemia (e. g. angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers and mineralocorticoid receptor antagonists). New oral potassium binders may enhance treatment opportunities in this respect.

Schlüsselwörter

Hyperkaliämie - Herzinsuffizienz - Inhibitoren des Renin-Angiotensin-Aldosteron-Systems - Patiromer - Natrium-Zirkonium-Cyclosilikat

Key words

hyperkalemia - heart failure - renin-angiotensin-aldosterone system inhibitors - patiromer - sodium-zirconium-cyclosilicate
 

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