Practical patient care appraisals with use of new potassium binders in heart failure and chronic kidney diseases

Abstract

Hyperkalaemia is a life-threatening condition leading to significant morbidity and mortality. It is common in heart failure and in chronic kidney disease (CKD) patients due to the diseases themselves, which often coexist, the high co-presence of diabetes, the fluctuations in renal function, and the use of some drugs [i.e. renin-angiotensin-aldosterone system (RAAS) inhibitors]. Hyperkalaemia limits their administration or uptitration, thus impacting on mortality. New K+ binders, namely patiromer and sodium zirconium cyclosilicate (ZS-9), are an intriguing option to manage hyperkalaemia in heart failure and/or CKD patients, both to reduce its fatal effects and to let clinicians uptitrate RAAS inhibition. Even if their real impact on strong outcomes is still to be determined, we hereby provide a practical approach to favour their use in routine clinical practice in order to gain the correct confidence and provide an additive tool to heart failure and CKD patients’ wellbeing. New trials are welcome to fill the gap in knowledge.

Sodium-glucose cotransporter-2 inhibitors and abnormal serum potassium: a real-world, pharmacovigilance study

“…Recently, the FIDELIO-DKD trial demonstrated that the nonsteroidal mineralocorticoid receptor antagonist finerenone can slow the progression of kidney disease and prevent cardiovascular events in people with T2DM and CKD, but an increased hyperkalemia risk was also observed 16 . However, the optimal strategy for managing chronic hyperkalemia remains uncertain; whereas the DIAMOND et al trial demonstrated that new potassium binders might facilitate greater RAASi use, 42,43 such drugs currently lack long-term clinical experience and are expensive. Concerns remain for the long-term safety of sodium polystyrene sulfonate, especially considering serious gastrointestinal adverse effects, but this remains the most commonly used potassium binder.…”