Novel approaches to management of hyperkalaemia in kidney transplantation

Abstract

Purpose of reviewMedications used frequently after kidney transplantation, including calcineurin inhibitors, angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, beta blockers and antimicrobials, are considered the leading culprit for posttransplant hyperkalaemia in recipients with a well functioning allograft. Other risk factors include comorbidities such as diabetes, hypertension and heart failure; and consumption of a potassium-enriched diet. We review the mechanisms for hyperkalaemia following kidney transplantation that are addressed using nonpharmacological and pharmacological interventions. We also discuss emerging therapeutic approaches for the management of recurrent hyperkalaemia in solid organ transplantation, including newer potassium binding therapies. Recent findingsPatiromer and sodium zirconium cyclosilicate are emerging potassium binders approved for the treatment of hyperkalaemia. Patiromer is a polymer that exchanges potassium for calcium ions. In contrast, sodium zirconium cyclosilicate is a nonpolymer compound that exchanges potassium for sodium and hydrogen ions. Both agents are efficacious in the treatment of chronic or recurrent hyperkalaemia and may result in fewer gastrointestinal side effects than older potassium binders such as sodium polystyrene sulfonate and calcium polystyrene sulfonate. Large-scale clinical studies have not been performed in kidney transplant patients. Patiromer may increase serum concentrations of tacrolimus, but not cyclosporine. Sodium zirconium cyclosilicate does not appear to compromise tacrolimus pharmacokinetics, although it may have a higher sodium burden.

Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options

“…Hyperkalemia is a common complication in RT with a reported incidence ranging from 25 to 44% in RT on calcineurin inhibitors (CNIs) (22). It is a life-threatening complication that may increase the length of stay (23). Hyperkalemia in the RT is usually seen in association with renal tubular acidosis and can occur even without insulin deficiency, metabolic acidosis, decreased eGFR or decreased distal sodium delivery.…”

Assessment of Oxidative Stress Markers in Hypothermic Preservation of Transplanted Kidneys

“…Creatinine and diuresis had linear characteristics, while potassium had the phase of increase at day 2. Medications used frequently after kidney transplantation, including calcineurin inhibitors, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and antimicrobials, are considered the leading culprit for posttransplant hyperkalemia in recipients with a well-functioning allograft [ 60 ]. Lingering hyperkaliemia may have a cause in high pre-transplant plasma potassium [ 61 ] or may be caused by postoperative complications and immunosuppression [ 62 ].…”

Kalium – was Intensivmediziner wissen sollten

“…Patiromer und Natrium-Zirkonium-Cyclosilikat sind Optionen zur Behandlung asymptomatischer Hyperkaliämie. Ihre Wirksamkeit, bessere Verträglichkeit und vergleichbare Kosten im Vergleich zu bisher verfügbaren Kaliumbindern machen sie zu einer Therapieoption bei chronischer Hyperkaliämie nach Nierentransplantation [32].…”