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Case Reports in Transplantation
Volume 2012, Article ID 586859, 3 pages
Case Report

Fludrocortisone Therapy in Renal Transplant Recipients with Persistent Hyperkalemia

1Department of Pharmacy & Abdominal Organ Transplantation, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
2Department of Medicine and Transplant Nephrology, Montefiore Medical Center, Bronx, NY 10467, USA

Received 1 August 2012; Accepted 23 August 2012

Academic Editors: F. Keller and R. Zhang

Copyright © 2012 K. Marfo and D. Glicklich. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hyperkalemia after kidney transplantation is a common electrolyte disturbance and the risk factors are multifactorial. Pharmacotherapeutic agents for chronic management of hyperkalemia in kidney transplant patients may be relatively contraindicated or provide suboptimal efficacy. Fludrocortisone, an endogenous mineralocorticoid mimics the actions of aldosterone, hence hyperkalemia reversal. We describe three- case series of persistent hyperkalemia with demonstrated benefit from fludrocortisone therapy. Our three renal transplant recipients with multiple emergency room visits for elevated serum potassium levels despite treatment with diuretics, sodium bicarbonate, and sodium polystyrene sulfonate responded well to fludrocortisones therapy. Upon fludrocortisone initiation and maintenance therapy, all three patients experienced a decline in serum potassium levels to normal reference range.