Hyperkalaemia is a life-threatening condition, resulting from decreased renal function or dysfunctional homoeostatic mechanisms, often affecting patients with cardiovascular (CV) disease. Drugs such as renin-angiotensin-aldosterone system inhibitors (RAASi) are known to improve outcomes in CV patients but can also cause drug-induced hyperkalaemia. New therapeutic options exist to enhance potassium excretion in these patients. To this aim, we reviewed pharmacological properties and available data on patiromer and sodium zirconium cyclosilicate for the treatment of hyperkalaemia. These agents have been shown in randomized trials to significantly reduce serum potassium in patients with hyperkalaemia on renin-angiotensin-aldosterone system inhibitors. Additional research should focus on their long-term effects/safety profiles and drug-drug interactions.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392412 | PMC |
| http://dx.doi.org/10.1093/eurheartj/suy035 | DOI Listing |
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Background: Hyperkalemia, generally defined as serum potassium levels greater than 5.0 mEq/L, poses significant clinical risks, including cardiac toxicity and muscle weakness. Its prevalence and severity increase in patients with chronic kidney disease (CKD), diabetes mellitus, and heart failure (HF), particularly when compounded by medications like Angiotensin converting inhibitors, Angiotensin receptor blockers, and potassium sparing diuretics.
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NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
Hyperkalemia is a potentially life-threatening condition frequently encountered in clinical practice, particularly among patients with chronic kidney disease, heart failure, diabetes, and hypertension and those undergoing treatment with renin-angiotensin-aldosterone system inhibitors (RAASi). The management of chronic and acute hyperkalemia is complex and requires timely intervention to prevent severe complications such as cardiac arrhythmias and sudden death. Traditional therapeutic approaches to chronic hyperkalemia, including dietary potassium restriction, use of diuretics, and administration of cation-exchange resins like sodium polystyrene sulfonate, often suffer from limitations like gastrointestinal side effects, variable efficacy, delayed onset of action, and RAASi treatment discontinuation.
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Division of Nephrology, Department of Medicine, University of North Carolina Kidney Center, Chapel Hill, NC and the WG (Bill) Hefner Salisbury VA Medical Center, Salisbury, NC. Electronic address:
Two potassium (K) binders-patiromer sorbitex calcium and sodium zirconium cyclosilicate-are recommended by international guidelines for the management of hyperkalemia. There is, however, no universally accepted best practice for how to appropriately utilize K binders in the long-term clinical management of CKD. A panel of eight US-based nephrologists convened in October 2022 to develop a consensus statement regarding utilizing K binders in clinical practice to help manage patients with nonemergent, persistent/recurrent hyperkalemia in CKD.
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