Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting

Abstract

Options for the management of hyperkalemia, particularly chronic hyperkalemia in the outpatient setting, are limited. Both sodium zirconium cyclosilicate and patiromer are emerging therapies that may provide long-term management of hyperkalemia, particularly in patients with underlying heart failure or CKD as well as those taking an RAS inhibitor, an aldosterone antagonist, or both.

Barriers to guideline mandated renin–angiotensin inhibitor use: focus on hyperkalaemia

“…reducing high potassium foods, 45 , 46 chronic diuretic administration appropriate for kidney function, and up-titration (especially in patients with comorbid HF). Additionally, it is also achieved by dose reduction or discontinuation of culprit medications that play a role in impairing renal potassium excretion, including RAASi, non-steroidal anti-inflammatory agents, and heparin 47 …”

A curious case of persistently relapsing hyperkalemia in an ESRD patient on maintenance hemodialysis following bioprosthetic aortic valve replacement – a potential case for the use of the new agent, patiromer, for hyperkalemia management

“…As such, there is an important unmet need for novel therapeutic options for the chronic management of patients at risk for hyperkalemia. Potential therapies in development may change the treatment landscape in the near future (6,14,15). …”

“…Patiromer was developed by Relypsa, Inc (14-16). The active ingredient is Patiromer sorbitex calcium which consists of the active moiety, Patiromer, a nonabsorbed potassium-binding polymer, and a calcium-sorbitol counterion.…”

Hyperkalemia Associated with Renin-Angiotensin-Aldosterone System Inhibition in Patients with Heart Failure; Underexplored and Overrated?

“…Hyperkalemia may be managed with novel potassium-binding agents, such as patiromer and sodium zirconium cyclosilicate. However, one has to be careful in prescribing these newly marketed agents, as their long-term safety is not yet well-established [3]. Future research should focus on studying the potential role of various potassium-lowering strategies in enabling the use of RAAS inhibitors in a broader range of HF patients, such as those with chronic kidney disease.…”