Potassium binding for conservative and preservative management of chronic kidney disease.

Abstract

Hyperkalemia is a life-threatening complication of chronic kidney disease (CKD). Risk factors include advanced kidney impairment, diabetes, hypertension, heart failure, and consumption of a K-enriched diet. High-K diets provide health benefits to include reductions in blood pressure, stroke risk, and osteoporosis. Individuals at the highest risk for developing hyperkalemia are those who would benefit most from high K diets. Inhibitors of the renin--angiotensin--aldosterone system (RAASi) are effective in reducing cardiovascular events and slowing the progression of CKD, yet hyperkalemia is a risk factor. Discussed are new strategies facilitating use of both high-K diets and pharmacology to preserve kidney function and reduce cardiovascular events. Sodium zirconium cyclosilicate and patiromer are new K-binding drugs approved for the treatment of hyperkalemia. Both are efficacious in the short-term and long-term treatment of hyperkalemia. These binders are effective in treating hyperkalemia while facilitating RAASi therapy. Hyperkalemia is a life-threatening condition. New K-binding drugs allow for optimal use of pharmacological therapy, such as RAASi, enhancing their cardiorenal protection. Health benefits from consumption of high K foods may also be enhanced by use of these binders. In conclusion, there are new well tolerated and effective K-binding agents for acutely and chronically managing hyperkalemia.