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New therapies for hyperkalemia.

Silvia J Leon1,2, Oksana Harasemiw2,3, Navdeep Tangri1,2,3

  • 1Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba.

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Summary
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Two new therapies, patiromer and ZS-9, effectively manage hyperkalemia in chronic kidney disease and heart failure patients. These treatments may allow continued use of renin-angiotensin aldosterone system (RAAS) inhibitors at optimal doses.

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Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Renin-angiotensin aldosterone system (RAAS) inhibitors are crucial for chronic diseases but hyperkalemia limits their use in chronic kidney disease (CKD) and heart failure.
  • Hyperkalemia is a significant barrier to optimal RAAS inhibitor therapy in CKD and heart failure patients.

Purpose of the Study:

  • To review the efficacy and safety of two novel hyperkalemia treatments: patiromer and ZS-9.
  • To evaluate the potential of these agents to enable continued RAAS inhibitor use in patients with CKD and heart failure.

Main Methods:

  • Review of clinical trial data on patiromer and ZS-9.
  • Analysis of safety and efficacy profiles of the two new agents in managing hyperkalemia.

Main Results:

  • Patiromer effectively lowers serum potassium in CKD and heart failure patients, with gastrointestinal events as the most common side effect.
  • ZS-9 (Lokelma) offers rapid and significant potassium reduction, suitable for acute hyperkalemia management, and is generally well-tolerated despite more adverse events than patiromer.

Conclusions:

  • Patiromer and ZS-9 demonstrate promise for chronic hyperkalemia management, potentially facilitating optimal RAAS inhibitor dosing.
  • Further research is warranted to confirm the benefits of maintaining RAAS inhibitor therapy after hyperkalemia episodes in CKD and heart failure populations.