Hyperkalemia is one of the most common electrolyte disorders in chronic kidney disease (CKD) and is associated with serious adverse outcomes. Hyperkalemia risk is even greater when CKD patients also have additional predisposing conditions such as diabetes or heart failure. Renin-angiotensin-aldosterone-system (RAAS) blockers are first-line treatments for cardio- and nephroprotection but their use in everyday practice is often limited due to K elevation, resulting in high rates of discontinuation.
This article provides an overview of factors interfering with K homeostasis and discusses recent data on newer therapeutic agents used for the treatment of hyperkalemia. A detailed literature search was performed in 2 major databases (Pubmed/MEDLINE and Scopus) from database inception up to April 2023.
Major clinical trials have tested new and promising kidney protective therapies such as sodium/glucose-cotransporter-2 inhibitors and mineralocorticoid-receptor-antagonists, with promising results. Until recently, the only treatment option for hyperkalemia was the cation-exchanging resin sodium-polystyrene-sulfonate. However, despite its common use, the efficacy and safety data of this drug in the long-term management of hyperkalemia are scarce. During the last decade, two novel orally administered K-exchanging compounds (patiromer and sodium-zirconium- cyclosilicate) have been approved the treatment of adults with hyperkalemia, as they both effectively reduce elevated serum K and maintain chronically K balance within the normal range with an excellent tolerability and no serious adverse events.
