If you’re living with a chronic kidney disease (CKD) and your nephrologist (kidney specialist) has started talking to you about your potassium levels, it’s important that you listen. Potassium is an essential mineral that is important for your overall health, including the functioning of your nerves, muscles and heart. Your doctor will monitor your potassium levels to help protect your health and support your quality of life.

Here’s what you need to know about the treatment options your doctor might offer if your potassium is high. Your doctor will also be able to tell you which treatment plan might be best for you, based on how well your kidneys are working, your daily life, and your overall health.

High Potassium and Chronic Kidney Disease

If your doctor tells you you have hyperkalemia, it means a blood test found higher-than-normal levels of potassium in your bloodstream. Kidney disease, including CKD, is the most common cause of high potassium. In fact, people living with chronic kidney disease are up to three times more likely to have high potassium than the rest of the population.

Your body needs some potassium to work properly, and you get it from the foods and drinks you consume. When potassium levels are normal, the kidneys typically remove any extra potassium. They filter it out of your blood stream and pass it into your urine.

If you’re living with CKD, your kidneys may not filter as well as they should. When this happens, they can’t remove excess potassium efficiently. Potassium can then build up in your body, leading to high potassium levels in your blood.

When the kidneys aren’t working well, potassium can build up in the blood and affect your health.

Treatments To Lower Potassium in an Emergency

If your potassium levels become very high or go up quickly, you may need urgent medical care. High potassium can become life-threatening because it can cause changes in your heart rhythm and, in severe cases, make your heart stop suddenly. In these cases, healthcare providers will usually give you medications through an intravenous (IV) line to help lower your potassium levels quickly.

One medication they may give you is insulin, which helps move more potassium from your blood into your cells. They may also give you albuterol, a medication often used for asthma that can also help lower potassium levels. In addition, they may give you calcium gluconate to protect your heart from the harmful effects of high potassium.

If your kidneys still aren’t working well or your potassium levels stay high, you may need dialysis. Hemodialysis — the most common type of dialysis — uses a machine to filter excess potassium and other waste products from your blood when your kidneys can’t do this on their own.

Other Parts of a Treatment Plan for Hyperkalemia

If you have high potassium but it’s not an emergency — or if you’ve recovered from emergency levels of high potassium and now need to manage your levels on a daily basis — you have several options for the treatment of hyperkalemia. You and your nephrology team can decide which approach is best for you. You may end up with a combination of treatments for the management of hyperkalemia.

Managing high potassium often means using a combination of treatments, tailored to how well your kidneys are working and your daily life.

1. Try Diuretics

Diuretics, also called water pills, are medications that help your body make more urine. This, in turn, can help you get rid of more potassium, since it’s usually excreted when you urinate.

It’s important to note that these may not work as well if your kidneys aren’t able to produce urine, which can happen in CKD.

2. Consider Potassium Binders

Potassium binders are powdered medications mixed with water and taken by mouth. They attach to potassium in your gastrointestinal tract so it leaves your body through your stool instead of entering your bloodstream and then passing through your kidneys to be excreted when you pee.

These medicines are usually not the first treatment you’ll try, but they can help if your potassium levels stay high despite other treatments.

3. Make Other Medication Adjustments

Some medications can cause high potassium. These include:

• Medication for hypertension (high blood pressure)
• Anti-inflammatory medications, such as nonsteroidal anti-inflammatories (NSAIDs)
• Antibiotics
• Immunosuppressants

Not all medications in these categories cause high potassium, and the ones that can cause it, won’t cause it in everyone who takes them.

If you’re taking any of these medications, you may need to work with your doctors to adjust the dose or switch you to a different option that won’t affect your potassium levels.

It’s important to make sure your body is still getting the treatment and support it needs. That’s why you should always make these changes with the guidance of a healthcare professional.

4. Avoid Salt Substitutes

If you’re using a salt substitute because you’re trying to consume less sodium, you may be taking in much more potassium than you realize. Many salt substitutes are high in potassium to mimic the taste of salt. Using these regularly can overwhelm your kidneys and make it harder for your body to remove extra potassium.

5. Follow an Eating Plan

Some foods contain more potassium than others. While your body does need some potassium to work properly, you also want to avoid hypokalemia (low potassium). It’s important that you get clear medical advice about how much potassium you need and which foods you should limit, avoid, or eat freely. You may also need to start reading food labels more carefully to figure out what you should and shouldn’t consume.

A registered dietitian who works with people with CKD can help you create a meal plan that meets your potassium goals, includes foods you enjoy, and provides enough calories to stay healthy. Your nephrologist can refer you to a dietitian if you’re not sure where to find one.

6. Have Regular Blood Tests

If you’re living with a CKD, your doctor may already monitor your potassium levels. If not, ask them about getting a blood test.

Once you’ve been diagnosed with hyperkalemia, it’s also important to get follow-up blood tests. These tests can tell you and your doctors how well your treatment for high potassium is working and whether any changes are needed to keep your levels in balance. Blood tests can also give you doctor information about how well your kidneys are working, which can influence your overall CKD treatment plan.

7. Avoid Supplements and Herbs

Some herbs and dietary supplements can raise your blood potassium levels. Before starting any new supplement, talk to your doctor first. They can tell you whether a supplement is safe or if you should avoid it. Your doctor may also check your potassium levels after you start a new supplement to make sure it isn’t causing problems.

8. Know What Symptoms To Watch For

Knowing the signs and symptoms might help you catch hyperkalemia early. This can be tricky, because some people have no symptoms, while others have mild or vague symptoms or symptoms that come and go.

Watch for symptoms such as:

• Unexplained nausea
• Muscle weakness
• Tingling
• Numbness
• Diarrhea
• Belly pain

Very high potassium levels can cause more serious symptoms. These may include:

• Shortness of breath
• Heart palpitations or arrhythmias (a fluttering, racing, or irregular heartbeat)
• Chest pain
• Severe nausea and vomiting

Some people may also feel like their limbs are numb or have extreme muscle weakness. If you have these symptoms, seek medical care right away.

Talk to Your Doctor

If you’re living with CKD, talk to your doctor about your potassium levels. They may already be checking them regularly and know your baseline, but you can ask if you’re unsure. Even if your potassium levels aren’t high, your doctor can explain your risk of developing high potassium and help you make a plan to prevent it.

If you know your potassium levels are high — or if they sometimes come back high — work with your doctor to monitor them and create a treatment plan if needed. Taking an active role in managing your potassium levels can help protect your health and support your quality of life.

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On MyKidneyDiseaseTeam, people share their experiences with kidney disease, get advice, and find support from others who understand.

What treatments have worked for you when it comes to managing your potassium levels with chronic kidney disease? Let others know in the comments below.