Acute kidney injury (AKI) is frequently seen in hospitalized patients and its incidence increases with the severity of illness. Recent studies have further illuminated the interdependent relationship between AKI and chronic kidney disease (CKD). CKD and proteinuria have been demonstrated to be risk factors for AKI. Moreover, the previous dogma that prognosis is excellent for patients who recover after AKI episodes may not be universally accurate as CKD is emerging as a long-term consequence after AKI. Short-term mortality is lower in CKD patients with AKI.
Patients with chronic kidney disease (CKD) are at an increased risk of developing hyperkalemia, which can be potentially life threatening. Hyperkalemia is frequently encountered with renin-angiotensin-aldosterone system inhibitor (RAASi) therapy use in patients with CKD and often results in the underdosing or discontinuation of these drugs. RAASi therapy has been proven to delay the progression of CKD, ameliorate proteinuria, and reduce the overall risk of cardiovascular morbidity and mortality. Patiromer is a sodium-free, potassium-binding polymer used for the treatment of hyperkalemia. We present a case series of four patients with Stage 4 or 5 CKD in whom the initiation of dialysis was delayed with the use of patiromer. For one patient, dialysis was delayed by 18 months, whereas the remaining three patients, in whom hyperkalemia was one of the main complications, remain dialysis independent to date.
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