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Clinical Practice Guidelines – Treatment of Acute Hyperkalaemia in Adults – July 2020 2

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Clinical Practice Guidelines – Treatment of Acute Hyperkalaemia in Adults – July 2020 2 Clinical Practice Guidelines Treatment of Acute Hyperkalaemia in Adults Final version: June 2020 Review date: June 2025 Authors: Dr Annette Alfonzo Consultant Nephrologist & Clinical Director, Faculty member of European Resuscitation Council, Victoria Hospital Kirkcaldy, Fife Dr Alexander Harrison Consultant in Nephrology and Intensive Care, Brighton and Sussex University Hospitals NHS Trust Dr Richard Baines Consultant Nephrologist and Head of Renal and Transplant Service, University Hospitals of Leicester NHS Trust Dr Ann Chu Academic Clinical Fellow Renal Medicine and Medical Education, Imperial College London Mr Simon Mann Renal Pharmacist, Lancashire Teaching Hospitals NHS Foundation Trust Mr Murdoch MacRury Patient representative Endorsements The National Institute for Health and Care Excellence (NICE) has accredited the process used by the Renal Association to produce its Clinical Practice Guidelines. Accreditation is valid for 5 years from January 2017. More information on accreditation can be viewed at www.nice.org.uk/accreditation Method used to arrive at a recommendation The recommendations for the first draft of this guideline resulted from a collective decision reached by informal discussion by the authors and, whenever necessary, with input from the Chair of the Clinical Practice Guidelines Committee. If no agreement had been reached on the appropriate grading of a recommendation, a vote would have been held and the majority opinion carried. However this was not necessary for this guideline. Conflicts of Interest Statement All authors made declarations of interest in line with the policy in the Renal Association Clinical Practice Guidelines Development Manual. Further details can be obtained on request from the Renal Association. Acknowledgements The authors wish to thank Dr Charlie Tomson, retired Consultant Nephrologist and former Chair of the UK Renal Association (2010-2012), Professor Ketan Dhatariya, Chair of the Joint British Diabetes Society for In- Patient Care (JBDS-IP), Dr Clare Crowley, Consultant Pharmacist (Medicines Saftety) at Oxford University Hospitals and Mr Murdoch MacRury for his insight into the treatment of hyperkalaemia from a patient’s perspective. We also wish to acknowledge the contributions of the original writing group whose collaborative efforts produced the 2014 Hyperkalaemia guideline. Renal Association Clinical Practice Guidelines – Treatment of Acute Hyperkalaemia in Adults – July 2020 2 Contents Executive Summary of changes since 2014 Hyperkalaemia Guideline ................................................................5 Guideline development ........................................................................................................................................7 Introduction ..........................................................................................................................................................8 Summary of Clinical Practice Guidelines for Hyperkalaemia ............................................................................ 10 Tables ................................................................................................................................................................. 17 Figures ............................................................................................................................................................... 18 Summary of Audit Measures ............................................................................................................................. 19 Hyperkalaemia in the Community (Guidelines 1.1 – 12.1) ................................................................................ 22 Introduction ................................................................................................................................................... 22 Patient monitoring (Guidelines 1.1-1.2) ....................................................................................................... 26 Management of patients receiving RAASi drugs (Guidelines 2.1-2.7).......................................................... 30 Threshold for treatment of hyperkalaemia (Guideline 3.1) ......................................................................... 33 Indications for hospital assessment (Guidelines 4.1 - 4.2) ........................................................................... 35 Treatment: Dietary interventions (Guideline 5.1) ....................................................................................... 37 Treatment: Sodium bicarbonate (Guideline 6.1) ......................................................................................... 39 Treatment: Diuretics (Guideline 7.1) ........................................................................................................... 41 Treatment: Calcium resonium (Guideline 8.1) ............................................................................................ 42 Treatment: Patiromer (Guidelines 9.1-9.3) ................................................................................................. 44 Treatment: Sodium zirconium cyclosilicate (Guidelines 10.1-10.3) ............................................................ 49 Prevention (Guidelines 11.1-11.3) ................................................................................................................ 53 Treatment Algorithm: Community (Guideline 12.1) .................................................................................... 57 Hyperkalaemia in Hospital ................................................................................................................................. 59 Introduction ................................................................................................................................................... 59 Clinical assessment (Guidelines 13.1-13.2) ................................................................................................... 61 ECG and cardiac monitoring (Guidelines 14.1-14.2) ..................................................................................... 63 Laboratory analysis (Guidelines 15.1-15.3) ................................................................................................... 68 Treatment (Guidelines 16.1-16.6) ................................................................................................................. 73 Blood monitoring (Guidelines 17.1-17.2) .................................................................................................... 101 Treatment of hyperkalaemia in haemodialysis patients (Guidelines 18.1-18.4) ........................................ 105 Referral to specialist services and escalation of care (Guidelines 19.1-19.6) ............................................. 110 Minimum standards for patient transfer (Guidelines 20.1-20.2) ................................................................ 112 Prevention (Guidelines 21.1-21.4) ............................................................................................................... 114 Renal Association Clinical Practice Guidelines – Treatment of Acute Hyperkalaemia in Adults – July 2020 3 Treatment Algorithm: Hospital (Guidelines 22.1) ...................................................................................... 118 Hyperkalaemia in Resuscitation ...................................................................................................................... 120 Introduction ................................................................................................................................................. 120 References ................................................................................................................................................... 121 Hyperkalaemic cardiac arrest – Special circumstance (Guidelines 23.1-23.2) ............................................ 121 Audit Measure ............................................................................................................................................. 121 Rationale (Guidelines 23.1) ......................................................................................................................... 121 References ................................................................................................................................................... 122 Resuscitation strategy in dialysis patients (Guidelines 24.1-24.2) ............................................................. 123 Treatment: Calcium chloride (Guidelines 25.1) .......................................................................................... 128 Treatment: Insulin-glucose (Guidelines 25.2)............................................................................................. 129 Treatment: Sodium bicarbonate (Guidelines 25.3) .................................................................................... 132 Treatment: Initiation of dialysis during cardiac arrest (Guidelines 25.4) ................................................... 133 Prevention (Guidelines 26.1-26.2) ............................................................................................................... 140 Lay summary .................................................................................................................................................... 143 Appendices .....................................................................................................................................................
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