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Correction of metabolic acidosis in patients with chronic kidney disease by increasing fruit and vegetable intake or bicarbonate supplementation can improve hyperkalemia.[26,27] However, sodium bicarbonate supplementation needs to be monitored in individuals with a history of heart failure, because it can lead to volume overload.[28] Addressing constipation with laxatives and increasing fibre intake can improve gastrointestinal potassium clearance.[20] The following resource highlights the management of constipation, including both nonpharmacologic and pharmacologic strategies, in patients with chronic kidney disease: Additional medications The primary purpose of initiating additional medications (e.g., diuretics, sodium-glucose cotransporter-2 inhibitors) is to manage underlying conditions, such as hypertension or heart failure, with the secondary benefit of mitigating hyperkalemia through their mechanisms of action

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Understanding these mechanisms and safety considerations helps patients appreciate why certain effects occur, particularly during the initial treatment phase