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A new area for the management of hyperkalaemia with potassium binders: clinical use in nephrology
1Université de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithématique 1433, Inserm U1116, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Association Lorraine de Traitement de l'Insuffisance Rénale, Nancy, France.
Abstract:
Chronic kidney disease (CKD) patients and more so CKD patients treated with renin-angiotensin-aldosterone system inhibitors (RAASi) are prone to experience hyperkalaemia, a condition associated with an increased risk of death. This represents a true dilemma in daily practice since RAASi are the cornerstones of nephroprotective and cardioprotective strategies in CKD patients, as well as in hypertensive patients with or without CKD. The recent availability in the USA and EU of the potassium-binding resin Patiromer, together with sodium zirconium cyclosilicate (SZC), which was more recently approved in the EU and the US, may lead to a paradigm shift both in the treatment of hyperkalaemia and in enabling RAASi maintenance. Whether potassium normalization, potentially combined with a RAASi maintenance strategy, may translate into improved cardiovascular and renal outcomes needs be tested prospectively.
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