Advances in treatment of hyperkalemia in chronic kidney disease.
BACKGROUND
Hyperkalemia is a frequent electrolyte disorder associated with life-threatening cardiac arrhythmias and sudden death. Patients prone to hyperkalemia have chronic kidney disease (CKD) either alone or in conjunction with diabetes or heart failure (HF). Although agents inhibiting the renin-angiotensin-aldosterone-system (RAAS) are currently the first-line treatments toward cardio- and nephroprotection, their administration often leads to potassium elevation in such patients and results in high rates of treatment discontinuation.


METHODS
This article provides an overview of factors interfering with potassium homeostasis and discusses emerging potassium-lowering therapies for long-term management of hyperkalemia.


CONCLUSIONS
In recent randomized clinical studies, two new oral potassium-exchanging compounds, patiromer and sodium zirconium cyclosilicate, were shown to effectively normalize elevated serum potassium and chronically maintain potassium homeostasis in hyperkalemic patients treated with RAAS blockers. Both agents exhibit good tolerability and were not associated with serious adverse effects. Although additional research is required, these drugs are promising for lowering the risk of incident hyperkalemia associated with RAAS blockade use in people with diabetes or HF who have CKD. They also provide the opportunity to test whether patients who could not previously receive RAAS blockade may benefit from their cardio- and renoprotective effects.
a 1 Aristotle University of Thessaloniki, Department of Nephrology, Hippokration Hospital , Thessaloniki, Greece.|b 2 Aristotle University of Thessaloniki, Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital , Thessaloniki, Greece.
Pantelis A
PA
Sarafidis
a 1 Aristotle University of Thessaloniki, Department of Nephrology, Hippokration Hospital , Thessaloniki, Greece.|b 2 Aristotle University of Thessaloniki, Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital , Thessaloniki, Greece.
Panagiotis I
PI
Georgianos
c 3 The University of Chicago Medicine, Department of Medicine, American Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism , Chicago, IL, USA.
George L
GL
Bakris
D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology; D006706:Homeostasis; D006801:Humans; D006947:Hyperkalemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D011108:Polymers / Q000627:therapeutic use; D011137:Polystyrenes / Q000627:therapeutic use; D011188:Potassium / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects; D017640:Silicates / Q000627:therapeutic use
D011108:Polymers; D011137:Polystyrenes; D017640:Silicates; C568789:patiromer; C003321:polystyrene sulfonic acid; C000597310:sodium zirconium cyclosilicate; D011188:Potassium
chronic kidney disease; hyperkalemia; patiromer; renin-angiotensin-aldosterone blockers; sodium zirconium cyclosilicate