
Profesor Invitado: Dr. Jorge Eduardo Rico Fontalvo
Especialista en Nefrología
Objetivo de Aprendizaje:
- Comprender los componentes clave de un algoritmo de manejo crónico del potasio, incluyendo la evaluación inicial del paciente y la estratificación del riesgo.
- Identificar estrategias terapéuticas para optimizar y mantener tratamientos como MRA, SGLT2i y iSRAA, incorporando medidas no farmacológicas y el uso oportuno de quelantes de potasio.
- Reconocer la importancia del monitoreo continuo de potasio y función renal para realizar ajustes dinámicos del tratamiento y preservar el beneficio cardio-renal a largo plazo.
Referencias:
- Kovesdy CP. Management of hyperkalaemia in chronic kidney disease. Nat Rev Nephrol. 2014 Nov;10(11):653-62.
- Vardeny O, et al. Incidence, predictors, and outcomes related to hypo- and hyperkalemia in patients with severe heart failure treated with a mineralocorticoid receptor antagonist. Circ Heart Fail. 2014 Jul;7(4):573-9.
- Xu H, et al. Prevalence of hyperkalemia in DOPPS: a real-world, international cohort of hemodialysis patients. Poster presented at: European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) 54th Annual Congress; 2017 Jun 3–6; Madrid, Spain. DOI: 10.3252/pso.eu.54ERA.2017.
- Bem D, et al. The effect of hyperkalemia and long inter-dialytic interval on morbidity and mortality in patients receiving hemodialysis: a systematic review. Ren Fail. 2021 Dec;43(1):241-254.
- Nilsson E, et al. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J Cardiol. 2017 Oct 15:245:277-284.
- Chomicki J, et al. Evaluation of the incidence of hyperkalemia in patients prescribed spironolactone for the treatment of resistant hypertension. J Am Soc Hypertens. 2014;8(4S):e30. Abs. P-10.
- Khosla N, et al. Predictors of hyperkalemia risk following hypertension control with aldosterone blockade. Am J Nephrol. 2009;30(5):418-24.
- Epstein M, et al. Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors. Am J Manag Care. 2015 Sep;21(11 Suppl):S212-20.
- Thomsen RW, et al. Elevated potassium levels in patients with chronic kidney disease: occurrence, risk factors and clinical outcomes-a Danish population-based cohort study. Nephrol Dial Transplant. 2018 Sep 1;33(9):1610-1620.
- Thomsen RW, et al. Elevated Potassium Levels in Patients With Congestive Heart Failure: Occurrence, Risk Factors, and Clinical Outcomes: A Danish Population-Based Cohort Study. J Am Heart Assoc. 2018 May 22;7(11):e008912.
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314.
- Clase CM, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020 Jan;97(1):42-61.
- Garred CH, et al. Adherence and Discontinuation of Optimal Heart Failure Therapies According to Age: A Danish Nationwide Study. J Am Heart Assoc. 2022 Oct 4;11(19):e026187.
- Patel RB, et al. Kidney Function and Outcomes in Patients Hospitalized With Heart Failure. J Am Coll Cardiol. 2021 Jul 27;78(4):330-343.
- Smith KV, et al. Evaluation of the Usage and Dosing of Guideline-Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction Patients in Clinical Practice. J Pharm Pract. 2022 Oct;35(5):747-751.
- Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. 2004 Aug 5;351(6):585-92.
- Palmer BF, et al. Clinical Management of Hyperkalemia. Mayo Clin Proc. 2021 Mar;96(3):744-762.
- McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726.
- Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-e421.
- Kosiborod M, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA. 2014 Dec 3;312(21):2223-33.
- Roger SD, et al. Efficacy and Safety of Sodium Zirconium Cyclosilicate for Treatment of Hyperkalemia: An 11-Month Open-Label Extension of HARMONIZE. Am J Nephrol. 2019;50(6):473-480.
- Spinowitz BS, et al. Sodium Zirconium Cyclosilicate among Individuals with Hyperkalemia: A 12-Month Phase 3 Study. Clin J Am Soc Nephrol. 2019 Jun 7;14(6):798-809.
- Fishbane S, et al. The randomized DIALIZE-Outcomes trial evaluated sodium zirconium cyclosilicate in hemodialysis. Kidney Int. 2025 Oct;108(4):686-694.