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Hyperkalemia in CKD: an overview of available therapeutic strategies

Davide Costa1, Gemma Patella2, Michele Provenzano3

  • 1Department of Law, Economics and Sociology, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Frontiers in Medicine
|August 16, 2023
PubMed

Insights

Hyperkalemia (HK) in chronic kidney disease (CKD) patients increases mortality risk. New potassium-lowering agents may allow continued use of vital renin-angiotensin-aldosterone system inhibitors (RAASi) in CKD patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Pharmacology

Background:

  • Hyperkalemia (HK) is a serious complication in patients with chronic kidney disease (CKD).
  • Elevated serum potassium (sKsK) correlates with increased risks of end-stage renal disease, arrhythmias, and mortality.
  • Discontinuation of renin-angiotensin-aldosterone system inhibitors (RAASi) due to HK exacerbates these risks.

Purpose of the Study:

  • To review the epidemiology, pathogenesis, etiology, and classification of HK in non-dialysis CKD (ND CKD) patients.
  • To outline current strategies for managing plasma potassium levels in ND CKD.
  • To highlight the role of new hypokalemic agents in optimizing RAASi therapy.

Main Methods:

  • Updated narrative review of existing literature on hyperkalemia in ND CKD patients.
  • Analysis of the prognostic impact of HK on mortality and renal disease progression.
  • Evaluation of current and emerging therapeutic strategies for potassium control.

Main Results:

  • HK is a significant risk factor for adverse outcomes in CKD patients.
  • RAASi therapy is often interrupted due to HK, despite its cardio-nephroprotective benefits.
  • New agents like patiromer and sodium zirconium cyclosilicate (SZC) offer potential for chronic HK management and continued RAASi use.

Conclusions:

  • Effective management of HK is crucial for CKD patients to maintain beneficial therapies like RAASi.
  • Patiromer and SZC represent advancements in treating HK, potentially improving outcomes for patients with heart and chronic renal failure.
  • Optimizing potassium control strategies is essential for improving the prognosis of ND CKD patients.

Keywords:
RAAS-blockadechronic kidney diseasehypokalemic agentspotassium binderserum potassium

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