Abstract

Mohammed K. Alwaily*

ABSTRACT

Background: Hyperkalemia is a frequent and life-threatening complication among patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). Methodology: This narrative review synthesizes evidence from epidemiological studies, historical management strategies, advances in dialysis-based approaches, pharmacological innovations, and emerging technological interventions. Results: Hyperkalemia affects more than 70% of maintenance HD patients annually, with recurrent episodes in the majority. Traditional management strategies—dietary restriction, potassium-binding resins, and dialysate adjustments—proved effective but limited by safety and tolerability concerns. Conclusion: The management of hyperkalemia in HD patients has progressed from empirical, generalized approaches to more patient-centered, evidence-based strategies. Integration of precision dialysis, novel pharmacotherapies, technological monitoring, and multidisciplinary care holds promise for reducing morbidity and mortality. However, accessibility and cost remain challenges, especially in resource-limited settings.