HYPERKALEMIA: AN INTEGRATIVE ANALYSIS OF PATHOPHYSIOLOGICAL MECHANISMS AND PERSONALIZED APPROACHES TO MANAGEMENT

Abstract

This paper presents an original analysis of potassium homeostasis disorders, systematized from the perspective of dominant pathophysiological mechanisms. Based on the study of 47 sources, including data from large registries, randomized clinical trials, and meta-analyses for the period 2015– 2026, the identification of five main variants of hyperkalemia is substantiated: hypoaldosteronic, redistributive, obstructive-tubular, drug-induced, and artifactual. It is shown that the choice of therapeutic strategy should be determined not so much by the absolute potassium level as by the mechanism of its elevation. Particular attention is paid to the comparative characteristics of traditional and innovative approaches to correction, including an analysis of the effectiveness of zirconium cyclosilicate and patiromer in the context of their physiological action. An original algorithm for differentiated patient management is proposed, taking into account both clinical and laboratory data and potential genetic determinants of potassium metabolism.