Assessing Potassium-Lowering Pharmacotherapy

Patients with chronic kidney disease (CKD) who develop hyperkalemia are at risk for serious adverse outcomes. The risk is increased when patients with CKD have comorbidities such as diabetes or heart failure. Management of patients with CKD presents challenges related to balancing the cardio- and renoprotective benefits of renin angiotensin aldosterone system (RAAS) blockers with the increased risk of hyperkalemia.

Erasmia Sampani, MD, and colleagues at Aristotle University of Thessaloniki, Greece, provided an overview of factors that interfere with serum potassium homeostasis and highlighted newer therapeutic agents available for the treatment of hyperkalemia. The researchers performed a literature search in PubMed/MEDLINE and Scopus from database inception to April 2023.

Therapeutic options for the management of hyperkalemia in patients with CKD had been limited to restriction of dietary potassium, correction of metabolic acidosis with bicarbonate solutions, or administration of sodium polystyrene sulfonate; however, those approaches were often problematic and unsuccessful.

During the past 10 years, two novel orally administered potassium-exchanging resins, patiromer and sodium zirconium cyclosilicate, have been shown to safely and effectively reduce elevated serum potassium in patients being treated with RAAS blockers. The agents effectively reduce elevated serum potassium and maintain potassium balance within the normal range with excellent tolerability and no serious adverse events.

Studies examining the safety and efficacy of new kidney protective therapies such as sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists (MRAs) have shown promising results. SGLT-2 inhibitors and finerenone, a newer MRA, offer additional therapeutic options with a beneficial effect on potassium homeostasis.

“The combination of these factors is expected to lower the prevalence of hyperkalemia and independently decrease the adverse impact of hyperkalemia on outcomes,” the researchers said.

Source: Expert Opinion on Pharmacotherapy