[What's new in hyperkalemia management?]

Area of Science:

• Nephrology
• Internal Medicine
• Clinical Pharmacology

Background:

• Hyperkalemia is a common and serious condition, particularly in patients with chronic kidney disease (CKD) or those treated with renin-angiotensin-aldosterone system inhibitors (iRAAS).
• Effective management of hyperkalemia is essential to prevent mortality and avoid interrupting vital cardio- and nephroprotective therapies like iRAAS.
• Current treatment options, such as polystyrene sulfonate, face challenges with patient acceptability and safety concerns.

Purpose of the Study:

• To review the current landscape of hyperkalemia management.
• To evaluate emerging potassium-binding agents and their potential role in clinical practice.
• To discuss adjunctive therapies and the need for evidence-based treatment guidelines.

Main Methods:

• Literature review of clinical studies and guidelines on hyperkalemia management.
• Analysis of safety and efficacy data for existing and novel potassium-lowering agents.
• Discussion of treatment strategies in the context of common comorbidities and concomitant medications.

Main Results:

• Polystyrene sulfonate's use is limited by tolerability issues and recent safety concerns.
• New potassium binders, patiromer and zirconium sulfonate, are available but require further evaluation for long-term use and acceptability.
• Combination therapies, including thiazide diuretics or SGLT2 inhibitors with iRAAS, show promise for kalemia control in CKD patients.

Conclusions:

• There is a need for clear recommendations on the positioning of various hypokalemic treatments.
• Treatment selection should be individualized based on patient comorbidities and the broader pharmacological effects of the chosen agents.
• Further research is needed to establish the long-term efficacy, safety, and patient-reported outcomes of novel hyperkalemia therapies.