Hyperkalaemia Drug Combination — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyHyperkalaemia Drug CombinationRACP Adult Medicine

A 50-year-old man with CKD stage 3b is commenced on spironolactone for HF. K+ rises to 6.2 mmol/L. Which drug combination creates the highest hyperkalaemia risk?

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Correct answer: A — ACEi + MRA in CKD

ACEi + MRA in CKD: each reduces K+ excretion independently, and CKD impairs overall potassium handling. SGLT2i actually mildly lowers K+.

Reference: AMH – 2025; eTG – 2025 – Cardiovascular