HWN Suggests

Potassium Binders

Most K+ binders have a delayed onset of action and should never be the sole treatment of a hyperkalemic emergency. K+ binders are used for the management of nonemergent and chronic hyperkalemia. They are combined with dietary counseling, medication adjustments and elimination of K+ sources such as K+ supplements and K+ containing salt substitutes. In this capacity, they enable patients to stay on critical medications such as inhibitors of the renin-angiotensin-aldosterone system (RAAS inhibitors) including angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs) and aldosterone antagonists (such as spironolactone and eplerenone). RAAS inhibitors are crucial in…

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Articles of Interest

Are Newer Potassium Binding Agents Truly Better? Rethinking Sodium Polystyrene Sulfate and Emerging Therapies for Hyperkalemia

Sodium polystyrene sulfate (SPS) — a potassium sodium exchanger — was historically the main treatment for hyperkalemia. However, concerns about gastrointestinal (GI) adverse events, such as intestinal necrosis, led to the development of newer, more expensive agents like patiromer and sodium zirconium cyclosilicate (SZC). These newer treatments employ similar mechanisms of action; patiromer exchanges calcium for potassium in the colon, and SZC binds potassium in exchange for hydrogen and sodium cations.

Can Novel Potassium Binders Liberate People with Chronic Kidney Disease from the Low-Potassium Diet?

The advent of new potassium binders provides an important breakthrough in the chronic management of hyperkalemia for people with CKD. In addition to the direct benefits of managing hyperkalemia, many researchers and clinicians view these new medications as a possible means to safely transition patients away from the low-potassium diet to a more healthful eating pattern.

New Potassium Binders for the Treatment of Hyperkalemia: Current Data and Opportunities for the Future

Hyperkalemia is a challenging clinical problem for clinicians caring for patients with CKD, diabetes mellitus, or heart failure. The new agents on the horizon seem to offer better predictability, tolerability, and safety for patients with hyperkalemia. Beyond the treatment of hyperkalemia, patiromer and ZS-9 might also enable more patients to be started or maintained on guideline-recommended RAASi. This concept is actively being investigated, as is the expansion of RAASi in populations excluded from previous studies because of hyperkalemia concerns.

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Among the different possibilities for treating hyperkalemia, recently, attention has been focused on the GI elimination of potassium, mainly because of the availability of new drugs, such as patiromer and sodium zirconium cyclosilicate.

Novel potassium binders: a clinical update

Overall, patiromer appears to be a well-tolerated potassium binder with an acceptable adverse event profile. It has a role in the chronic management of HK, and is efficacious in CKD and heart failure patients. The addition of patiromer may allow a higher proportion of patients to continue RAAS inhibitors, but the benefit in long-term clinical outcome has yet to be proven. SZC may be preferable in the acute setting due its quicker onset of action and achievement of normokalaemia. With fewer drug interactions, patients may find this more tolerable. However, its adverse event of oedema may exacerbate an already present problem in heart failure and CKD patients.

Potassium Binders for Hyperkalemia in CKD Compared, Characterized

Citing a lack of head-to-head comparisons, investigators compared the potassium binders indirectly using data from 13 randomized controlled trials (RCTs) involving 2150 patients with CKD and hyperkalemia. The control condition was placebo in 11 trials and sodium polystyrene sulfonate (SPS) in 2 trials.

Potassium Binders in CKD vs Potassium is Good in CKD

SPS, a Na+/K+ cation exchange resin, is the longest reigning potassium binder, having received FDA approval in 1958. While often scrutinized for the lack of large, randomized controlled trials to prove its efficacy, there are a host of retrospective data suggesting it works.

Utilization of Potassium Binders for the Management of Hyperkalemia in Chronic Kidney Disease: A Position Statement by US Nephrologists

Two potassium (K+) binders—patiromer sorbitex calcium and sodium zirconium cyclosilicate—are recommended by international guidelines for the management of hyperkalemia. There is, however, no universally accepted best practice for how to appropriately utilize K+ binders in the long-term clinical management of CKD.