Medications to control electrolyte imbalances

Treating electrolyte imbalances caused by kidney failure can be difficult because many medicines lower some electrolyte levels while raising other levels. Your doctor may need to regularly monitor your electrolyte levels.

Potassium

Severe chronic renal insufficiency (CRI) and kidney failure can increase potassium levels above the normal range (hyperkalemia). Two types of medicines may be used to lower potassium levels.

• Potassium binders, such as sodium polystyrene sulfonate (Kayexalate), block the absorption of dietary potassium.
• Diuretics increase the amount of potassium released by the kidneys through the urine. This may be an option if you have some remaining kidney function.

Hemodialysis is the best way to lower potassium levels if kidney failure has developed rapidly and potassium levels are very high.

Calcium and phosphorus

Kidney failure causes an increased breakdown of bone and abnormal metabolism of calcium, phosphorus, vitamin D, and parathyroid hormone (PTH). This often leads to a bone disease called renal osteodystrophy. Medicines used to restore proper metabolism of these chemicals may include the following:

• Phosphate binders. These contain calcium. An example is calcium carbonate. They are used to raise levels of calcium and lower levels of phosphorus in the bloodstream. Phosphate binders that contain aluminum should be avoided, to prevent aluminum poisoning.
• Non-calcium phosphate binders. These are calcium- and aluminum-free. Examples are sevelamer and lanthanum. They are also used to control serum phosphate and reduce PTH levels.
• Calcitriol. This is a vitamin D derivative. It may be used to increase calcium levels and help store excess phosphate in bone. While taking calcitriol, you will be watched closely for hypercalcemia.