Hyperkalaemia with Finerenone — ESENeph MCQ

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HardElectrolyte DisordersHyperkalaemia with FinerenoneESENeph

A patient with CKD taking ramipril, dapagliflozin and finerenone has potassium 5.8 mmol/L without ECG changes. Repeat sampling excludes haemolysis. What medication action is required while other causes are assessed?

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Correct answer: D — Withhold finerenone and treat hyperkalaemia

Confirmed potassium 5.8 mmol/L requires finerenone to be withheld under product and trial-based monitoring protocols, followed by treatment of reversible causes and repeat measurement. Re-initiation at a lower dose can be considered only after potassium is controlled. Merely “considering” reduction understates the action required at this concentration. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO 2024 Clinical Practice Guideline for CKD. https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf; UK Kidney Association Hyperkalaemia Guideline. https://guidelines.ukkidney.org/hyperkalaemia/