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New therapies for hyperkalemia

Leon, Silvia J.a,b; Harasemiw, Oksanab,c; Tangri, Navdeepa,b,c

Current Opinion in Nephrology and Hypertension: May 2019 - Volume 28 - Issue 3 - p 238–244
doi: 10.1097/MNH.0000000000000500

Purpose of review Although renin–angiotensin aldosterone system (RAAS) inhibitors have become the mainstay treatment for patients with chronic diseases, hyperkalemia is a major contributory deterrent to their use in patients with chronic kidney disease (CKD) and heart failure. For the first time in 50 years, two new therapies (patiromer and ZS-9) have recently emerged for the concomitant treatment of hyperkalemia in these patients. The objective of this review is to discuss the efficacy and safety of these new agents.

Recent findings Patiromer effectively reduces serum potassium in patients with CKD and heart failure, even with the concomitant use of RAAS inhibitors. The most common adverse events in clinical trials were gastrointestinal events. ZS-9 (Lokelma) rapidly reduces serum potassium levels and to a greater magnitude, and has a role in the acute management of hyperkalemia. Despite having more adverse events than patiromer, ZS-9 is overall well tolerated.

Summary These new therapies show promising results for the chronic management of hyperkalemia, whilst also potentially allowing for the concomitant use of RAAS inhibitors at optimal doses. More research is needed to examine the benefits of continuation of RAAS inhibitors after an episode of hyperkalemia in patients with CKD and heart failure.

aDepartment of Community Health Sciences, Max Rady College of Medicine, University of Manitoba

bChronic Disease Innovation Centre, Seven Oaks General Hospital

cDepartment of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Correspondence to Navdeep Tangri, Chronic Disease Innovation Centre, Seven Oaks General Hospital, 2LB19, 2300 McPhillips Street, Winnipeg, Manitoba, Canada. Tel: +1 204 631 3837; e-mail:

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