How can hyperkalemia be treated in patients with ESRD?

Administering insulin is a well-established method for treating hyperkalemia, especially in cases associated with renal failure. Insulin promotes the uptake of potassium into cells, which can temporarily lower serum potassium levels. This is particularly effective when used in conjunction with glucose to avoid hypoglycemia.

It is important to note that changes in diet alone may not sufficiently manage hyperkalemia in patients with end-stage renal disease (ESRD), as dietary restrictions on potassium may not always be feasible or adequate given the underlying condition.

Diuresis with loop diuretics can help facilitate the excretion of potassium in the urine, thereby reducing elevated potassium levels. However, in patients with ESRD, diuretics may be less effective due to impaired kidney function.

Increasing fluid intake alone is generally not a viable option, as excessive fluid can lead to volume overload in ESRD patients, exacerbating their condition.

Thus, the most appropriate acute treatment for hyperkalemia in patients with ESRD is the administration of insulin, which serves to shift potassium intracellularly and provide a rapid decrease in serum potassium levels. In chronic management, the use of loop diuretics may be considered if the patient still has some residual kidney function, but it is not the