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Expert Opinion on the Management of Hyperkalemia in Patients with Cardiorenal Diseases Treated with Renin Angiotensin Aldosterone System Inhibitors: An Indonesian Perspective

ACTA MEDICA INDONESIANA · Vol. 58 No. 1 (2026)

ISSN
2338-2732, 0125-9326
Terbit
2026-04-09
Penerbit
The Indonesian Society of Internal Medicine
Bahasa
eng
Lisensi
creativecommons.org/licenses/by/4.0

Abstrak

Hyperkalemia (serum potassium >5.0 mEq/l) is a significant complication in patients with heart failure, chronic kidney disease, and diabetes mellitus, particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Both hyperkalemia and RAASi interruption are associated with increased cardiovascular events, hospitalizations, and mortality. This expert opinion document, developed between January and December 2024 through a systematic process, aims to establish guidance for hyperkalemia treatment in Indonesian patients with cardiorenal diseases receiving RAASi therapy, addressing the unique challenges within the Indonesian healthcare context. A comprehensive literature review of international guidelines and regional studies was conducted by a panel of 11 expert specialists (3 cardiologists, 6 internist-nephrologists, and 2 internist-cardiologists), who evaluated 29 statements covering diagnosis, monitoring, prevention, and treatment of hyperkalemia. Of the 29 statements, 26 reached consensus: 17 statements achieved very high agreement (≥90%) and 9 attained high agreement (≥67% – <90%). The agreed statements covered key areas, including potassium monitoring frequency, RAASi dose optimization strategies, dietary modifications, and treatment thresholds. Three statements regarding alternative therapeutic approaches did not receive agreement (<67%) due to limited local availability and cost considerations. Key recommendations include structured monitoring protocols for high-risk patients, strategies for RAASi dose optimization while managing hyperkalemia risk, and specific interventions adapted to local resources. This document provides a practical approach for managing hyperkalemia in Indonesian patients with cardiorenal diseases while maintaining optimal RAASi therapy, considering local Indonesian healthcare resources and constraints.

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Kuntjoro HarimurtiAfiliasi tidak diketahui7
Hamzah ShatriAfiliasi tidak diketahui4
Alvina WidhaniAfiliasi tidak diketahui3
Idrus AlwiAfiliasi tidak diketahui3
Suhardjono SuhardjonoAfiliasi tidak diketahui3
Taufik IndrajayaAfiliasi tidak diketahui3
Siti SetiatiAfiliasi tidak diketahui2
Ika Prasetya WijayaAfiliasi tidak diketahui2
Em YunirUniversity of Indonesia2
Ikhwan RinaldiAfiliasi tidak diketahui2
Maruhum Bonar H MarbunAfiliasi tidak diketahui2
Evy YunihastutiAfiliasi tidak diketahui2
Chyntia Olivia Maurine JasirwanAfiliasi tidak diketahui2
Maruhum Bonar Hasiholan MarbunAfiliasi tidak diketahui2
Rudi PutrantoAfiliasi tidak diketahui2
Anshari Saifuddin HasibuanAfiliasi tidak diketahui2
Sukamto KoesnoeAfiliasi tidak diketahui2
Dyah PurnamasariAfiliasi tidak diketahui2
Eka GinanjarAfiliasi tidak diketahui2
Arif MansjoerAfiliasi tidak diketahui2
Adityo SusiloAfiliasi tidak diketahui2
Juferdy KurniawanAfiliasi tidak diketahui2
Imam SubektiAfiliasi tidak diketahui2
Cleopas Martin RumendeAfiliasi tidak diketahui2
Yenny KandariniAfiliasi tidak diketahui2
Muhammad YusriAfiliasi tidak diketahui1
Huntari HarahapAfiliasi tidak diketahui1
ELFIANI ELFIANIAfiliasi tidak diketahui1
Fadil PramudyaAfiliasi tidak diketahui1

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Sumber metadata: OAI-PMH (metadata jurnal) http://www.actamedindones.org/index.php/ijim/oai, pertama di-harvest 8 Nov 2026, terakhir terlihat 8 Nov 2026.
Metadata asli (oai_dc) 
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	<dc:title xml:lang="en-US">Expert Opinion on the Management of Hyperkalemia in Patients with Cardiorenal Diseases Treated with Renin Angiotensin Aldosterone System Inhibitors: An Indonesian Perspective</dc:title>
	<dc:creator>Nugroho, Pringgodigdo</dc:creator>
	<dc:creator>Lydia, Aida</dc:creator>
	<dc:creator>Rasyid, Haerani Abdul</dc:creator>
	<dc:creator>Ali, Zulkhair</dc:creator>
	<dc:creator>Pranawa</dc:creator>
	<dc:creator>Nyoman Paramita Ayu</dc:creator>
	<dc:creator>Birry Karim</dc:creator>
	<dc:creator>Erwin Sukandi</dc:creator>
	<dc:creator> Nauli, Siti Elkana</dc:creator>
	<dc:creator>Muliawan, Hary Sakti </dc:creator>
	<dc:creator>Zulkarnain, Edrian</dc:creator>
	<dc:subject xml:lang="en-US">Hyperkalemia</dc:subject>
	<dc:subject xml:lang="en-US">Cardio-Renal Syndrome</dc:subject>
	<dc:subject xml:lang="en-US">Renin-Angiotensin System</dc:subject>
	<dc:subject xml:lang="en-US">Indonesia</dc:subject>
	<dc:description xml:lang="en-US">Hyperkalemia (serum potassium &amp;gt;5.0 mEq/l) is a significant complication in patients with heart failure, chronic kidney disease, and diabetes mellitus, particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Both hyperkalemia and RAASi interruption are associated with increased cardiovascular events, hospitalizations, and mortality. This expert opinion document, developed between January and December 2024 through a systematic process, aims to establish guidance for hyperkalemia treatment in Indonesian patients with cardiorenal diseases receiving RAASi therapy, addressing the unique challenges within the Indonesian healthcare context. A comprehensive literature review of international guidelines and regional studies was conducted by a panel of 11 expert specialists (3 cardiologists, 6 internist-nephrologists, and 2 internist-cardiologists), who evaluated 29 statements covering diagnosis, monitoring, prevention, and treatment of hyperkalemia. Of the 29 statements, 26 reached consensus: 17 statements achieved very high agreement (≥90%) and 9 attained high agreement (≥67% – &amp;lt;90%). The agreed statements covered key areas, including potassium monitoring frequency, RAASi dose optimization strategies, dietary modifications, and treatment thresholds. Three statements regarding alternative therapeutic approaches did not receive agreement (&amp;lt;67%) due to limited local availability and cost considerations. Key recommendations include structured monitoring protocols for high-risk patients, strategies for RAASi dose optimization while managing hyperkalemia risk, and specific interventions adapted to local resources. This document provides a practical approach for managing hyperkalemia in Indonesian patients with cardiorenal diseases while maintaining optimal RAASi therapy, considering local Indonesian healthcare resources and constraints.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2026-04-09</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/3231</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 58 No. 1 (2026): Acta Medica Indonesiana; 123</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/3231/858</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2026 Pringgodigdo Nugroho, Aida Lydia, Haerani Abdul Rasyid, Zulkhair Ali, Pranawa, Nyoman Paramita Ayu, Birry Karim, Erwin Sukandi, Siti Elkana  Nauli, Hary Sakti  Muliawan, Edrian Zulkarnain</dc:rights>
	<dc:rights xml:lang="en-US">https://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>