What are the recommended management strategies for a patient with hyperkalemia in primary care?

In primary care, the management of hyperkalemia should begin with confirming the diagnosis and assessing severity through repeat serum potassium measurement and evaluation of clinical context, including medication review and comorbidities such as chronic kidney disease or heart failure ¹ (Kreitzer et al., 2025). Immediate referral to secondary care is warranted if potassium levels are critically high (typically >6.0 mmol/L) or if there are ECG changes suggestive of cardiac toxicity ¹.

For mild to moderate hyperkalemia, initial management involves identifying and discontinuing or adjusting medications that contribute to elevated potassium, such as potassium-sparing diuretics, ACE inhibitors, ARBs, and NSAIDs ¹ (Kreitzer et al., 2025). Dietary potassium intake should be reviewed and moderated as appropriate ¹.

Addressing underlying causes such as acute kidney injury or metabolic acidosis is essential, and optimizing volume status may help reduce potassium levels ¹. In stable patients without severe hyperkalemia, potassium binders (e.g., sodium polystyrene sulfonate) may be considered cautiously in primary care, although their use is more established in specialist settings (Kreitzer et al., 2025).

Regular monitoring of serum potassium and renal function is recommended to guide ongoing management and prevent recurrence ¹ (Kreitzer et al., 2025). Patient education on symptoms of hyperkalemia and when to seek urgent care is also important ¹.

Overall, the primary care approach focuses on risk stratification, medication review, dietary advice, and monitoring, with urgent referral for severe cases or those with ECG changes, integrating both UK guideline recommendations and recent multidisciplinary consensus from the literature (Kreitzer et al., 2025).