Impact of hyperkalemia on tumor lysis syndrome and its role in the risk of cardiac arrest in oncology patients

Abstract

Potassium balance is crucial for cardiac function, and alterations such as hyperkalemia can lead to arrhythmias and cardiac arrest, especially in cancer patients. Tumor Lysis Syndrome (TLS), associated with aggressive neoplasms, causes a significant increase in serum potassium, raising cardiovascular risk. This study investigated the relationship between potassium levels and cardiac arrest in cancer patients, based on a review of 15 studies (2000-2025). The results showed that potassium levels above 6.0 mEq/L in TLS increase the risk of ventricular arrhythmias by 21% and mortality by 33%, acting as an independent predictor of cardiac arrest. Patients with obesity or chronic kidney disease (CKD) are at higher risk due to reduced renal excretion and the use of medications affecting the renin-angiotensin-aldosterone system. In Brazil, 16.1% of dialysis patients have hyperkalemia, with regional disparities in access to care. Preventive strategies include aggressive hydration, the use of rasburicase, and strict monitoring of electrolyte levels, while urinary alkalinization was discouraged. Proactive potassium management is essential to prevent cardiac complications, and public policies are needed to improve treatment access, as well as further research on biomarkers and personalized therapies.