Disorders of potassium homeostasis after kidney transplantation

Table 4 Common preventive and management strategies for post-transplant hyperkalemia and hypokalemia

	Hyperkalemia	Hypokalemia
Pre-transplant	Hold ACE inhibitor or ARB	Hold loop and thiazide diuretics, if applicable
	Add extra session of hemodialysis
Early post-transplant	Obtain ECG and administer IV calcium gluconate if appropriate	Obtain ECG and administer IV potassium chloride if appropriate
	Add extra session of hemodialysis	Use high K+ bath for hemodialysis if needed
	Correct insulin deficiency	Add KCl to replacement fluid
	Correct metabolic acidosis	Correct metabolic alkalosis
	Add loop diuretic	Avoid loop diuretic
	Avoid potassium-sparing diuretics	Add oral potassium supplement
	Address constipation	Consult dietician
	Minimize use of heparin
	Delay introducing sulfa antibiotic
	Consult dietician
Late post-transplant	Reduce or hold ACE inhibitor or ARB, potassium-sparing diuretic	Correct underlying cause, e.g., diarrhea
	Rule out obstruction	Add ACE inhibitor or ARB, potassium sparing diuretic
	Reduce or hold sulfa antibiotic, or switch to another prophylactic drug for Pneumocystis jirovecii	Add oral potassium supplement
	Add fludrocortisone	Identify and correct magnesium deficiency
	Correct metabolic acidosis	Consult dietician
	Optimize glycemic control
	Add oral patiromer or sodium zircomium cyclosilicate
	Consult dietician

ACE: Angiotensin-converting enzyme; ARB: Angiotensin II receptor blockers; ECG: Electrocardiogram.