Abstract
Hyperkalemia may cause life-threatening cardiac and neuromuscular alterations, and it is associated with high mortality rates. Its treatment includes a multifaceted approach, guided by potassium levels and clinical presentation. In general, treatment of hyperkalemia may be directed towards stabilizing cell membrane potential, promoting transcellular potassium shift and lowering total K+ body content. The latter can be obtained by dialysis, or by increasing potassium elimination by urine or the gastrointestinal tract. Until recently, the only therapeutic option for increasing fecal K+ excretion was represented by the cation-exchanging resin sodium polystyrene sulfonate. However, despite its common use, the efficacy of this drug has been poorly studied in controlled studies, and concerns about its safety have been reported. Interestingly, new drugs, namely patiromer and sodium zirconium cyclosilicate, have been developed to treat hyperkalemia by increasing gastrointestinal potassium elimination. These medications have proved their efficacy and safety in large clinical trials, involving subjects at high risk of hyperkalemia, such as patients with heart failure and chronic kidney disease. In this review, we discuss the mechanisms of action and the updated data of patiromer and sodium zirconium cyclosilicate, considering that the availability of these new treatment options offers the possibility of improving the management of both acute and chronic hyperkalemia.
Highlights
Potassium (K+) is a key element in body physiology
Sodium zirconium cyclosilicate (SZC) should only be given on non-dialysis days at starting doses of 5 g once daily, followed by titrating the dose according to the pre-dialysis serum potassium value after the long inter dialytic interval [79]
The development of new potassium-lowering agents, such as patiromer and SZC, has offered new opportunities for improving the management of hyperkalemia, even considering that, unlike sodium polystyrene sulfonate (SPS), these medications have proven their efficacy in large clinical trials in different clinical settings
Summary
Potassium (K+) is a key element in body physiology. It regulates many biological processes, such as acid–base homeostasis, hormone secretion, systemic blood pressure control and gastrointestinal motility [1]. Probably the most important role of K+ is its participation in generating bioelectricity, by establishing ion gradients and flows between the extracellular and intracellular spaces, regulating resting membrane potential and cellular excitability, which are essential to the function of excitable tissues, such as nerve, muscle and cardiac conduction tissues This function is a consequence of the high compartmentalization of K+, due to the ubiquitous presence of plasma membrane Na-K-ATPases, which pump sodium out of, and K+ into, the cell [2]. The first aim is to prevent cardiac consequences and lower serum potassium to safe levels as soon as possible; it is important to reduce the K+ body content, aiming to maintain serum potassium at normal values [14] The latter can be obtained by dialysis, or by increasing potassium elimination via urine or the gastrointestinal tract. We briefly discuss the pathophysiology of potassium homeostasis and hyperkalemia, focusing attention on the mechanisms of action and the clinical data of patiromer and sodium zirconium cyclosilicate, considering that these new treatments may represent a chance to improve the management of both acute and chronic hyperkalemia
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