A cross-sectional survey of 362 physicians across seven Central American countries and the Dominican Republic reveals substantial inconsistency in how clinicians define, monitor, and treat hyperkalemia — a potentially life-threatening elevation of blood potassium. Outpatient intervention thresholds varied, with 55.2% acting at serum potassium ≥5.5 mEq/L, while 35.6% waited until 6.0 mEq/L before emergency referral. Critically, access to potassium monitoring differed sharply by sector: 90.3% in private settings versus only 55.5% in public facilities. RAAS inhibitor modification — a guideline-discouraged reflex — was reported by 93% of respondents.
This survey matters because hyperkalemia sits at the intersection of heart failure, chronic kidney disease, and diabetes management — three conditions where RAAS inhibitors provide survival benefits. Reflexive discontinuation of these drugs to manage potassium, rather than using newer potassium binders like patiromer or sodium zirconium cyclosilicate, may inadvertently harm patients long-term. The 35-percentage-point monitoring gap between public and private sectors signals a systemic equity issue that could leave vulnerable populations undiagnosed until crisis. While the survey captures 362 responses from a large geographic footprint, self-reported physician behavior notoriously diverges from actual practice, and the sample skews toward Costa Rica and Honduras. This is a preprint not yet peer-reviewed, so findings should be interpreted cautiously. Still, the data offer a rare systematic baseline for a region largely absent from global cardiology and nephrology guideline discussions — making it incrementally valuable for regional health policy.