A modern view on hyperkalemia’s management

Abstract

The study demonstrated that sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) have dominated the management of hyperkalemia over 6 decades after being approved by the United States Food and Drug Administration (FDA) in 1958 because of their long term effi cacy but due to their affi liation with gastrointestinal side effects their usage has been insubstantial or limited. Earlier SPS was thought to work effectively for constipation along with sorbitol but later FDA found it to be causing colonic necrosis and increased mortality. CPS was useful in patients with high sodium load but there were cases with increased vascular calcifi cation. So, eventually in 2009, the FDA prohibited their long-term use for hyperkalemia. The shortcomings led to the development of “new generation” potassium binders including - patiromer and sodium-zirconium cyclosilicate (SZC / ZS-9). In clinical studies patiromer was found to be well tolerated and reduced hyperkalemia in patients with diabetes mellitus, chronic kidney disease, heart failure, hypertension to enhance cardiovascular and renal outcomes and also in patients on renin-angiotensin-aldosterone system inhibitors (RAASi) therapy. Cochrane reviews were conducted three times (2005, 2015, and 2020) for comparison of “old generation” potassium binders with the new generation” potassium binders however, from the point of view of safety, preference was given to the “new generation” potassium binders.