Hyperkalemia in two patients with diabetes mallitus and chronic kidney disease. Role of disrupted internal potassium balance

To identify factors associated with the development of hyperkalemia in patients with chronic kidney disease (CKD), we analyzed conditions present during episodes of hyperkalemia in two patients with insulin-dependent diabetes mellitus who had elevated serum potassium concentration ([K]) in ≥ 20% of the blood samples during both the pre-hemodialysis and the hemodialysis period. In both patients, conditions causing derangements in the internal potassium balance (exchanges of potassium between the intracellular and the extracellular compartment), including severe hyperglycemia (serum glucose concentration ≥ 400 mg/dL) and catabolic illnesses, were present in ≥ 75% of the instances of simple hyperkalemia ([K] ≥ 5.1 mmol/L) and almost all of the instances of severe hyperkalemia ([K] ≥ 6.0 mmol/L) during both the pre-hemodialysis and the hemodialysis periods. Derangements of the internal potassium balance, many of which are potentially preventable, can be a major cause of hyperkalemia in patients with CKD before or after starting chronic hemodialysis. Careful analysis of the conditions associated with and potentially causing hyperkalemia in CKD patients is imperative for both treatment and prevention purposes.