Diabetic nephropathy is a complication of diabetes that affects the kidneys. Hyperkalemia refers to high levels of potassium in the blood. Damage to the kidneys can result in hyperkalemia.

Diabetic nephropathy describes damage to the kidneys that occurs as a complication of diabetes. Prolonged high blood sugar levels damage the small blood vessels and tiny filters in the kidneys. It can also increase blood pressure. This places extra strain on the kidneys and causes them to work less effectively.

Hyperkalemia refers to high potassium levels. It typically occurs when the kidneys are unable to properly regulate potassium levels. Diabetic nephropathy can impact kidney function. As a result, uncontrolled or untreated diabetes can be a risk factor for developing hyperkalemia.

Read on to learn more about the connection between diabetic nephropathy and hyperkalemia. This article also looks at why individuals living with diabetes are at an increased risk of hyperkalemia.

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Diabetic nephropathy refers to a possible complication of diabetes that leads to kidney damage. One of the main functions of the kidneys is to filter blood. The body can then expel extra fluid and waste products through urine.

The kidneys contain nephrons, which consist of filtering units known as glomeruli. These units filter waste products and excess fluid from the body. This process is necessary to maintain a stable balance of certain substances, including potassium.

Hyperglycemia, or high blood sugar levels, can cause damage to the blood vessels and filters present in the kidneys. Hypertension, or high blood pressure, is also common in people with diabetes. It too can cause damage to the kidneys.

When the kidneys are unable to function correctly, they may not be able to sufficiently filter blood. When this occurs, too much potassium can accumulate in the blood. This is known as hyperkalemia and can cause health problems, such as affecting the heart.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diabetes is the leading cause of kidney disease. Roughly 1 in 3 adults living with diabetes will experience kidney disease. In a 2021 study, the prevalence of hyperkalemia in people with diabetic kidney disease was 37%.

Diabetes is a risk factor for hyperkalemia. Evidence notes that many mechanisms that occur with diabetes can contribute to a higher risk of developing hyperkalemia. These can include:


Prolonged high blood sugar levels can directly affect kidney function and lead to diabetic nephropathy. Hyperglycemia damages the small blood vessels in the kidneys. This impairs their ability to filter and regulate electrolytes, including potassium.


Evidence notes that 73.6% of individuals living with diabetes age 18 years or older have hypertension.

Certain medications to manage high blood pressure may increase the risk of hyperkalemia. These include renin-angiotensin-aldosterone system (RAAS) inhibitors. RAAS inhibitors work by dilating blood vessels and reducing blood pressure. However, they can also reduce potassium excretion by the kidneys.

Hyporeninemic hypoaldosteronism

This is a condition that affects the RAAS. This system plays an important role in electrolyte balance. As such, disruption to this system can cause hyperkalemia. A common risk factor for this condition is diabetes.


Osmolality refers to the concentration of dissolved particles in body fluids. Hyperosmolality describes when fluids have a high osmolality due to high levels of substances such as salt and glucose.

Due to factors such as hyperglycemia, people with diabetes may have a high blood osmolality. As such, people with diabetes may have high levels of potassium in their blood.

Insulin and glucagon levels

Both insulin and glucagon are hormones that help regulate blood sugar levels. They also play a role in helping to regulate potassium levels. As such, having irregular levels of these hormones, such as very low levels of insulin, can impact this regulation and lead to hyperkalemia.

Read more about those at higher risk of hyperkalemia.

Managing both diabetic nephropathy and hyperkalemia requires a multifaceted approach. This can include lifestyle changes, medications, and medical monitoring. Some options include:

Insulin therapy

For some individuals with diabetes, maintaining optimal blood glucose levels through insulin therapy is essential. By improving glucose uptake by cells, insulin can help prevent hyperkalemia. This works by reducing blood sugar levels and facilitating potassium entry into cells.

Insulin therapy can be a treatment option during severe cases of hyperkalemia.

SGLT2 Inhibitors

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of antidiabetic drugs that have shown promise in managing diabetic nephropathy. Unlike some other drugs, evidence notes that SGLT2 inhibitors can reduce the risk of hyperkalemia.

Calcium gluconate

In cases of severe hyperkalemia, a doctor can administer calcium salts. These salts may help stabilize the heart’s electrical activity, reducing the risk of dangerous cardiac arrhythmias associated with hyperkalemia.

Beta-2 adrenergic agonists

To help with hyperkalemia, a person can administer medications such as albuterol, a beta-2 adrenergic agonist. These medications can shift potassium from the bloodstream into cells, effectively reducing hyperkalemia.

Potassium binders

Certain medications known as potassium binders can attach to excess potassium in the gastrointestinal tract. By doing so, they prevent the excess potassium from absorbing into the bloodstream.

Read more about treatment options for diabetic kidney disease.

Diabetic nephropathy is a complication of diabetes, while hyperkalemia describes high blood potassium levels. The two conditions are closely linked. This is due to the impact diabetes can have on kidney function and potassium regulation.

Balancing blood sugar levels, addressing kidney function, and managing potassium levels are crucial for individuals with diabetic nephropathy and hyperkalemia. Treatment options can include insulin, SGLT2 inhibitors, calcium, albuterol, and potassium binders.