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Hyperkalemia, or high potassium, is something that people living with chronic kidney disease need to be aware of. Even though your heart and other organs rely on potassium to function properly, too much potassium in your bloodstream can pose serious health risks. You should be especially aware of these risks when taking new medications, because some medications’ side effects can include hyperkalemia.
Your potassium levels might not be your first thought when reaching for supplements and over-the-counter medications, which is why it’s important to tell your doctor or nephrologist (kidney specialist) what you’re taking, even if you don’t need a prescription for it. You can also keep this guide handy for a general idea of which medications can cause hyperkalemia.
Your kidneys typically remove the extra potassium from your blood, but when they’re unable to do so, hyperkalemia can be the result. Hyperkalemia affects just 2 percent to 3 percent of the general population, but people with chronic kidney disease are up to three times more likely to experience it.
High potassium isn’t always easy to spot — you might not have symptoms, or your symptoms might be so subtle that you overlook them or write them off. Any symptoms you have might come and go, or they might gradually become more intense. 
If you have chronic kidney disease, watch out for these initial signs of high potassium:
If left uncontrolled, hyperkalemia can cause heart problems. This is because potassium plays an important role in supporting your heart function. The following are signs that you have severe hyperkalemia, which is dangerous:
Get medical attention right away if you have these symptoms. High potassium at this level can be life-threatening.
Some people don’t realize they have hyperkalemia until they get a blood test called a serum potassium test. This test reflects your serum potassium levels (the concentration of potassium in a blood sample), measured in millimoles per liter.
Here’s what the results mean:
Doctors might also use an electrocardiogram (ECG or EKG) test to evaluate heart rhythm problems related to high potassium.
You’re already at a higher risk for hyperkalemia if you have chronic kidney disease because kidney damage prevents your kidneys from filtering excess potassium out of your blood and into your urine. The more advanced your kidney disease, the more likely you are to have high potassium.
The following medications can raise your blood potassium levels even further:
If you have chronic kidney disease, you might take beta-blockers to treat hypertension (high blood pressure) and reduce strain on your kidneys. Beta-blockers also treat many heart-related conditions, as well as a few conditions involving the nervous system.
Beta-blockers block specific chemical messengers in your body that control functions like your heart rate and blood pressure, including the hormone adrenaline. By blocking the hormone, beta-blockers prevent adrenaline from increasing your heart rate and constricting your blood vessels. As a result, your heart rate slows down, your blood vessels relax, and your blood pressure decreases.
Beta-blockers might be a big help for keeping your blood pressure in check and slowing kidney damage, but they can also contribute to hyperkalemia in two ways. They slow down the sodium-potassium pump, which is a part of your cells that helps keep sodium and potassium levels balanced inside and outside the cell. When this pump doesn’t function properly, potassium has trouble getting into your cells and builds up in your bloodstream instead.
In about 1 percent to 5 percent of people who take beta-blockers, the drugs indirectly block the release of renin. Renin is a kind of protein your kidneys make. It teams up with hormones called angiotensin and aldosterone to help balance sodium and potassium in your body. When renin is blocked, even indirectly, this system can’t function as it should.
Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin-receptor blockers (ARBs) are two more classes of medication you might take to lower your blood pressure and reduce kidney damage in chronic kidney disease.
ACE inhibitors work by slowing down your body’s production of angiotensin-2 (AT2), whereas ARBs work by blocking AT2 receptors in your blood vessels on which the angiotensin-2 acts.
AT2 is a hormone that helps regulate your blood pressure. It does this by narrowing your blood vessels if your blood pressure gets too low, which increases the pressure of blood against their inner walls. By blocking its effects, ACE inhibitors and ARBs prevent the high blood pressure that damages blood vessels in your kidneys.
ACE inhibitors and ARBs reduce your production of aldosterone, a hormone from your adrenal glands (hormone-producing glands on top of your kidneys). Aldosterone controls how much fluid your kidneys absorb and helps balance the electrolytes sodium and potassium.
By reducing aldosterone, ACE inhibitors also limit how much potassium your kidneys excrete through your urine. That means more potassium building up in your bloodstream and an increased risk of hyperkalemia. Your doctor may check your potassium levels before prescribing either of these drugs and schedule a follow-up potassium test a few weeks after you start them.
Diuretics are yet another class of medication you might take to control high blood pressure in chronic kidney disease.
Also called water pills, diuretics help your kidneys get rid of extra salt and water to reduce the total amount of blood in the blood vessels and fluid in your body. There are several types of diuretics:
Not all diuretics are associated with hyperkalemia — in fact, thiazide diuretics and loop diuretics are more likely to cause hypokalemia (too little potassium in your blood) and can treat hyperkalemia in some cases.
On the other hand, some potassium-sparing diuretics such as spironolactone, amiloride, and triamterene can raise the amount of potassium in your blood. They work by blocking sodium channels in a part of the kidney. This makes the kidneys take in less sodium and send less potassium out in the urine. Spironolactone also blocks the effects of aldosterone.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are over-the-counter pain relievers you likely have in your medicine cabinet. You might use them without a second thought to manage headaches, body aches, fevers, and other mild conditions that don’t necessarily call for a doctor’s visit.
NSAIDs work by stopping your body’s production of certain chemicals that cause inflammation. They’re great for reducing symptoms associated with inflammation, like pain and fevers, but they don’t treat underlying health conditions causing the inflammation.
Taking an occasional NSAID to manage pain might not affect your potassium levels, but using them frequently and for an extended period of time can damage your kidneys and reduce their ability to get rid of the extra potassium in your blood.
Generally, people with chronic kidney disease shouldn’t take NSAIDs. People without kidney disease should only take them for short periods — no more than three days for a fever and 10 days for pain. Talk to your doctor to find out if it’s safe for you to take NSAIDs for any reason.
Microbes are tiny germs that can’t be seen with the naked eye, such as bacteria, viruses, and some fungi. Doctors prescribe antibiotics to treat bacterial infections, which are infections caused by bacteria.
Many types of antibiotics treat a wide range of bacterial infections throughout the body. Some bacteria don’t make you sick, but other bacteria can cause illnesses like strep throat, urinary tract infections (UTIs), or pink eye, to name a few. They work by either killing the bacteria that cause these infections or stopping the bacteria from multiplying inside your body.
Not all antibiotics can cause hyperkalemia, but certain types can, like trimethoprim, which is generally used to treat UTIs.
On the other hand, pentamidine is an inhaled, anti-infective, antifungal medicine that prevents and treats a serious type of pneumonia caused by a fungus.
Both trimethoprim and pentamidine can cause hyperkalemia by blocking the sodium channels in certain parts of the kidney which, in turn, reduces the secretion of potassium in the urine and leads to hyperkalemia.
Talk to your doctor about how prescribed antimicrobials might increase your risk of hyperkalemia.
Your healthcare provider can guide you in making decisions about your health with chronic kidney disease, including whether to take medications that might increase your potassium levels.
If you’re at risk of hyperkalemia, your doctor might recommend regular blood tests to track your potassium levels. They may change your medications if any medications you take contribute to your high potassium.
On MyKidneyDiseaseTeam, people share their experiences with kidney disease, get advice, and find support from others who understand.
Which medications do you take that influence your potassium levels? Let others know in the comments below.
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