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It's Complicated: How to Manage High Potassium Level and Heart Failure

It's Complicated: How to Manage High Potassium Level and Heart Failure

This article is for people with heart failure who have high potassium levels, or anyone who wants to learn more about high potassium levels. The goal of this patient education activity is to educate patients who have heart failure about how to prevent or treat high potassium levels.

You will learn:

  • Why hyperkalemia (high-potassium level) is dangerous

  • What causes hyperkalemia

  • Why hyperkalemia is common in patients with heart failure

  • What medicines are used to treat hyperkalemia and improve heart failure

  • How you can make lifestyle changes to help lower your potassium levels and improve your heart failure

  • Questions to ask your doctor

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What Does Potassium Do?

Potassium is very important for the normal functioning of your muscles, heart, and nerves:

  • It helps to control your body's muscles as well as the muscles in your heart

  • It is important for normal transmission (communication) of electrical signals throughout the nervous system within the body

  • It helps manage the amount the fluids in your body and helps you to avoid getting dehydrated (not enough water)

Why Are High Levels of Potassium Harmful?

Hyperkalemia is a higher than normal level of potassium in the blood.

Too much potassium can affect the way your heart works. It can cause dangerous heart rhythm changes, called cardiac arrhythmias.

These arrhythmias can lead to a severe condition where the lower parts of your heart have trouble pumping blood. This can cause ventricular fibrillation, a life-threatening emergency.

What Causes Hyperkalemia?

There are a number of causes of hyperkalemia. A common one is kidney disease. The kidneys stop filtering out the potassium in your blood, which leads to an increased amount in your body.

Other causes include:

  • Type 1 diabetes

  • Some prescription and over-the-counter medicines, like blood pressure and heart medicines, and pain relievers

  • Getting too much potassium in the diet

  • Chronic kidney disease

Another cause is heart failure, and it is a common condition in patients who also have chronic kidney disease.

The Heart Disease-Kidney Disease-Hyperkalemia Connection

When the kidneys are damaged and can't filter your blood properly, potassium can build up in your bloodstream and cause hyperkalemia.

If hyperkalemia is not treated, it can interfere with the way your heart pumps blood, which can cause heart failure. And, some medicines used to treat heart failure can cause hyperkalemia.

Nurse practitioner Candice Halinski explains how to manage the conditions of chronic kidney disease, heart failure, and hyperkalemia.

Are There Medicines That Can Help?

Yes, medicines known as potassium binders help lower potassium levels in the blood.

Potassium binders work by "binding" to extra potassium so it can be eliminated from your body. These medicines can be taken safely with other heart and blood pressure medicines.

Two new potassium binders are:

  • Patiromer (Veltassa®)

  • Sodium zirconium cyclosilicate (Lokelma®)

An older potassium-binding medicine called sodium polystyrene sulfonate (Kayexalate®) may also be used.

It is important to tell your doctor what other medicines you are taking because some can raise potassium levels.

What About Dialysis?

If you have life-threatening hyperkalemia, which is causing heart failure, you may need dialysis.

Dialysis is the quickest and safest way to get rid of the excess potassium in your blood.

Can What You Eat Affect Potassium Level?

Yes. Your doctor may recommend you work with a dietitian or nutritionist to learn what foods you can eat and what foods to avoid.

Some steps you can take:

  • Avoid high-potassium foods, like bananas, cantaloupe, broccoli, milk, potatoes, tomatoes, and salt substitutes

  • Eat more low-potassium foods like blueberries, raspberries, cucumbers, white or brown rice, spaghetti, and macaroni

  • Reduce potassium in some foods like potatoes by soaking or boiling them before eating

How You Can Manage Hyperkalemia

  • Take your medicine as directed; add powder to water and drink your medicine each day

  • Manage your diet to lower the amount of potassium in the foods you are eating

Make sure you report the following to your doctor:

  • Symptoms like muscle cramping and fatigue, extreme shortness of breath

  • Side effects from potassium binders like diarrhea, nausea, constipation, numbness, and swelling

It's very important to stick to your treatment plan and tell your doctor if you have any health changes.

Questions to Ask Your Doctor

Managing your potassium level is an important part of treating your heart condition. Some questions you may want to ask your doctor include:

  • What is the best way to manage my potassium and my heart condition?

  • Are my heart medicines raising my potassium level?

  • Should I consider taking medicines to treat high potassium?

  • What side effects do those medicines have?

  • When should I seek emergency treatment?

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Authors and Disclosures


Candice Halinski, MHCDS, MSN, NP-C

Assistant Professor of MedicineDonald & Barbara Zucker School of MedicineHofstra UniversityNorthwell HealthGreat Neck, New York

Disclosure: Candice Halinski, MHCDS, MSN, NP-C, has disclosed no relevant financial relationships.

Clinician Reviewer

Susan L. Smith, MN, PhD

Senior Scientific Director, Medscape, LLC

Disclosure: Susan L. Smith, MN, PhD, has disclosed no relevant financial relationships.


Heather Lewin, MAT

Associate Scientific Director, Medscape, LLC

Disclosure: Heather Lewin, MAT, has disclosed no relevant financial relationships.


Donald Hannaford

Medical Writer, Rumson, NJ

Disclosure: Donald Hannaford has disclosed no relevant financial relationships.


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