Potassium binders for chronic hyperkalaemia in people with chronic kidney disease

Natale, Patrizia; Palmer, Suetonia C.; Ruospo, Marinella; Saglimbene, Valeria; Strippoli, Giovanni F.M.

doi:10.1002/14651858.cd013165

Cited by 13 publications

(13 citation statements)

References 28 publications

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“…Details of the PICOM questions and associated Cochrane Kidney and Transplant systematic reviews are provided in Table 2. 13,84,148,216,292,[378][379][380][381][382][383] All evidence reviews were conducted in accordance with the Cochrane Handbook, 384 and guideline development adhered to the standards of GRADE (Grading of Recommendation, Assessment, Development, and Evaluation). 385 Literature searches and article selection.…”

Section: Overview Of Processmentioning

confidence: 99%

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

Boer¹,

Caramori²,

Chan³

et al. 2020

Kidney International

782

549

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S20 Introduction S22 Summary of recommendation statements and practice points S30 Chapter 1: Comprehensive care in patients with diabetes and CKD S39 Chapter 2: Glycemic monitoring and targets in patients with diabetes and CKD S47 Chapter 3: Lifestyle interventions in patients with diabetes and CKD S58 Chapter 4: Antihyperglycemic therapies in patients with type 2 diabetes (T2D) and CKD S79 Chapter 5: Approaches to management of patients with diabetes and CKD S87 Methods for guideline development S96 Biographic and disclosure information S106 Acknowledgments S107 References The development and publication of this guideline were supported by KDIGO. The opinions or views expressed in this professional education supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the International Society of Nephrology or Elsevier. Dosages, indications, and methods of use for products that are referred to in the supplement by the authors may reflect their clinical experience or may be derived from the professional literature or other clinical sources. Because of the differences between in vitro and in vivo systems and between laboratory animal models and clinical data in humans, in vitro and animal data may not necessarily correlate with clinical results.

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Section: Overview Of Processmentioning

confidence: 99%

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

Boer¹,

Caramori²,

Chan³

et al. 2020

Kidney International

782

549

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“…Randomized trials have recently demonstrated efficacy and tolerability of new K-binders agents leading to remarkably lower rates of RAASI discontinuation as compared to traditional anti-hyperkalemic therapy [46,47]. These data call for real-world studies conducted in renal clinics, on large number of patients and with long follow up, to verify effectiveness on hard outcomes [48].…”

Section: Discussionmentioning

confidence: 99%

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care

et al. 2021

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Background: No study has explored the limitations of current long-term management of hyperkalemia (HK) in outpatient CKD clinics. Methods: We evaluated the association between current therapeutic options and control of serum K (sK) during 12-month follow up in ND-CKD patients stratified in four groups by HK (sK ≥ 5.0 mEq/L) at baseline and month 12: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). Results: We studied 562 patients (age 66.2 ± 14.5 y; 61% males; eGFR 39.8 ± 21.8 mL/min/1.73 m2, RAASI 76.2%). HK was “absent” in 50.7%, “resolving” in 15.6%, “new onset” in 16.6%, and “persistent” in 17.1%. Twenty-four hour urinary measurements testified adherence to nutritional recommendations in the four groups at either visit. We detected increased prescription from baseline to month 12 of bicarbonate supplements (from 5.0 to 14.1%, p < 0.0001), K-binders (from 2.0 to 7.7%, p < 0.0001), and non-K sparing diuretics (from 34.3 to 41.5%, p < 0.001); these changes were consistent across groups. Similar results were obtained when using higher sK level (≥5.5 mEq/L) to stratify patients. Mixed-effects regression analysis showed that higher sK over time was associated with eGFR < 60, diabetes, lower serum bicarbonate, lower use of non-K sparing diuretics, bicarbonate supplementation, and K-binder use. Treatment-by-time interaction showed that sK decreased in HK patients given bicarbonate (p = 0.003) and K-binders (p = 0.005). Conclusions: This observational study discloses that one-third of ND-CKD patients under nephrology care remain with or develop HK during a 12-month period despite low K intake and increased use of sK-lowering drugs.

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“…A previous systematic review of clinical studies evaluating the use of K 1 binders for treatment of chronic hyperkalemia in patients with CKD concluded that the current evidence is insufficient to inform clinical care or policy decision-making in the setting of peritoneal dialysis, hemodialysis, home-based hemodialysis, or transplantation. 3 While there is evidence that hyperkalemia (serum K 1 .5.0 mmol/L) is associated with an increased risk of adverse cardiovascular events in patients receiving maintenance hemodialysis, 38,77 the available evidence base and recommendations on how hyperkalemia should be managed in such patients are very limited. To address the gap in recommendations, this expert consensus statement was developed to provide healthcare professionals with guidance on best practice in serum K 1 monitoring, concomitant prescription of RAAS inhibitors, dietary K 1 restriction, prescription of K 1 binders, and other aspects of managing hyperkalemia in patients receiving maintenance hemodialysis.…”

Section: Overview and Future Directionsmentioning

confidence: 99%

“…While the body of evidence currently available supports the efficacy of SZC and patiromer in managing chronic hyperkalemia, evidence to support their role in the hemodialysis setting is limited. 3 To date, only one RCT has investigated newer K 1 binders in the hemodialysis setting, showing that SZC is efficacious in reducing serum K 1 concentration in patients receiving maintenance hemodialysis. 22 A prospective, randomized, open-label trial is underway to evaluate the efficacy of patiromer to reduce hyperkalemia in patients receiving maintenance hemodialysis (NCT03781089).…”

Section: Gaps In the Evidence Base And Future Directionsmentioning

confidence: 99%

“…H YPERKALEMIA, COMMONLY DEFINED as serum K 1 .5.0 mmol/L or .5.5 mmol/L, is a common electrolyte disturbance observed in patients with advanced stages of chronic kidney disease (CKD) and is associated with increased risk of life-threatening cardiac arrhythmias. [1][2][3][4] Generally, moderate hyperkalemia is defined as serum K 1 .5.5 mmol/L and severe hyperkalemia defined as serum K 1 .6.0 mmol/L. The risk of hyperkalemia is increased in patients with heart failure and diabetes and in patients receiving maintenance hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

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Consensus-Based Recommendations for the Management of Hyperkalemia in the Hemodialysis Setting

Fishbane

Charytan

Chertow

et al. 2022

Journal of Renal Nutrition

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Hyperkalemia (serum K 1 .5.0 mmol/L) is commonly observed among patients receiving maintenance hemodialysis and associated with increased risk of cardiac arrhythmias. Current international guidelines may not reflect the latest evidence on managing hyperkalemia in patients undergoing hemodialysis, and there is a lack of high-quality published studies in this area. This consensus guideline aims to provide recommendations in relation to clinical practice. Available published evidence was evaluated through a systematic literature review, and the nominal group technique was used to develop consensus recommendations from a panel of experienced nephrologists, covering monitoring, dietary restrictions, prescription of K 1 binders, and concomitant prescription of renin-angiotensin-aldosterone system inhibitors. Recent studies have shown that K 1 binders reduce the incidence of hyperkalemia, but further evidence is needed in areas including whether reduced-K 1 diets or treatment with K 1 binders improve patient-centered outcomes. Treatment of hyperkalemia in the hemodialysis setting is complex, and decisions need to be tailored for individual patients.

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Potassium binders for chronic hyperkalaemia in people with chronic kidney disease

Cited by 13 publications

References 28 publications

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care

Consensus-Based Recommendations for the Management of Hyperkalemia in the Hemodialysis Setting

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