Use of Fludrocortisone for Hyperkalemia in Chronic Kidney Disease Not Yet on Dialysis

• Published in: Electrolyte & blood pressure : E & BP Vol. 22; no. 1; pp. 8 - 15
• Main Authors: Eun Kyoung Lee, Won Seok Yang
• Format: Journal Article
• Language: Korean
• Published: 대한전해질학회 30.06.2024
• Subjects: Calcium polystyrene sulfonate; Chronic kidney disease; Fludrocortisone; Hyperkalemia
• ISSN: 1738-5997

Background: Hyperkalemia is a frequent and potentially lethal complication of chronic kidney disease (CKD). We retrospectively examined the potassium-lowering effect of oral fludrocortisone and its adverse effects in hyperkalemic CKD patients not yet on dialysis. Methods: Thirty-three patients (23 men and 10 women, ages 69±14 years) were included. To control hyperkalemia at the outpatient clinic, twenty-one patients (Group 1) received fludrocortisone (0.05-0.1mg/day) without changes in angiotensin II receptor blockers (ARBs) and calcium polystyrene sulfonate (CPS), while twelve patients (Group 2) were treated with fludrocortisone in addition to stopping ARBs and/or adding low-dose CPS. Results: Fludrocortisone was administered for a median of 169 days (interquartile range, 47-445). At the first follow-up after fludrocortisone administration, serum potassium dropped from 6.14±0.32mEq/L to 4.52±1.06mEq/L (p<0.001) in Group 1 and from 6.37±0.35mEq/L to 4.08±0.74mEq/L (p<0.01) in Group 2. Ten patients in Group 1 and five patients in Group 2 measured serum potassium levels at four outpatient visits before and after fludrocortisone administration, respectively. The frequency of serum potassium ≥6.0mEq/L decreased from 19/40 (48%) to 2/40 (5%) (p<0.001) in Group 1 and from 11/20 (55%) to 0/20 (0%) (p<0.001) in Group 2. Eleven patients experienced sodium retention-related problems after fludrocortisone administration: 7 with worsening leg edema, 2 with pleural effusions, and 2 with pulmonary edema. Conclusion: In pre-dialysis CKD patients, fludrocortisone at low doses effectively reduced serum potassium levels; however, sodium retention was a common adverse effect.