title: Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting.
abstract: OBJECTIVE
  Emerging treatment options for the management of chronic hyperkalemia in the outpatient setting are reviewed.
  
  
  CONCLUSIONS
  Current treatment options for the management of hyperkalemia are limited and often accompanied by serious adverse effects. Two investigational drugs for the treatment of hyperkalemia are being evaluated in Phase III trials: sodium zirconium cyclosilicate and patiromer. Both of these drugs are administered orally and act by enhancing potassium's removal, predominantly through the gastrointestinal tract. The safety and efficacy of sodium zirconium cyclosilicate and patiromer were evaluated in Phase II and III trials. Both agents were studied in patients with chronic mild-to-severe hyperkalemia, chronic kidney disease (CKD), or heart failure as well as those taking a renin-angiotensin system (RAS) inhibitor, an aldosterone antagonist, or both therapies. These clinical trials found that sodium zirconium cyclosilicate and patiromer normalized serum potassium levels quickly and maintained normalized serum potassium levels over several weeks. Both medications caused a rapid decrease in serum potassium, with two studies examining efficacy endpoints for 12 weeks or longer. The overall frequency of adverse effects in these clinical trials was low, with gastrointestinal adverse events being the most commonly observed.
  
  
  CONCLUSIONS
  Options for the management of hyperkalemia, particularly chronic hyperkalemia in the outpatient setting, are limited. Both sodium zirconium cyclosilicate and patiromer are emerging therapies that may provide long-term management of hyperkalemia, particularly in patients with underlying heart failure or CKD as well as those taking an RAS inhibitor, an aldosterone antagonist, or both.
authors.affiliation: Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL.
authors.forename: Amy
authors.initials: A
authors.lastname: Henneman
authors.affiliation: Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL.
authors.forename: Erenie
authors.initials: E
authors.lastname: Guirguis
authors.affiliation: Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Grace
authors.affiliation: Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL.
authors.forename: Dimple
authors.initials: D
authors.lastname: Patel
authors.affiliation: Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL.
authors.forename: Bhoomi
authors.initials: B
authors.lastname: Shah
mesh_terms: D000553:Ambulatory Care / Q000379:methods / Q000639:trends*; D000818:Animals; D002908:Chronic Disease; D002986:Clinical Trials as Topic / Q000379:methods; D019468:Disease Management; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011108:Polymers / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D017640:Silicates / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D011108:Polymers; D017640:Silicates; C568789:patiromer; C000597310:sodium zirconium cyclosilicate; D011188:Potassium