Pharmacological strategies to manage hyperkalaemia: out with the old, in with the new? Not so fast horizontal ellipsis

Review Urology & Nephrology

Adverse effects during treatment with renin-angiotensin-aldosterone system inhibitors; should we stay or should we stop?

Silvia J. Leon et al.

Summary: The benefits and harms of stopping therapy with RAASi after adverse events or in patients with advanced CKD are discussed. Evidence suggests that stopping RAASi may increase the risk of cardiovascular disease.

CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION (2023)

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Article Urology & Nephrology

Patiromer utilization in patients with advanced chronic kidney disease under nephrology care in Germany

Roberto Pecoits-Filho et al.

Summary: This study describes the use of patiromer in patients with CKD stage 3-5 in Germany. The results show that most patients continue treatment with patiromer for at least 1 year and experience a reduction in serum potassium levels.

CLINICAL KIDNEY JOURNAL (2023)

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Article Cardiac & Cardiovascular Systems

Stopping renin-angiotensin system inhibitors after hyperkalemia and risk of adverse outcomes

Yang Xu et al.

Summary: Stopping renin-angiotensin system inhibitors (RASi) after an episode of hyperkalemia may reduce the risk of recurrent hyperkalemia, but is associated with higher risks of death and cardiovascular events.

AMERICAN HEART JOURNAL (2022)

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Article Urology & Nephrology

Hyperkalemia-Related Discontinuation of Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in CKD: A Population-Based Cohort Study

Silvia J. Leon et al.

Summary: Discontinuation of RAAS inhibitors is associated with adverse clinical outcomes in patients with CKD, including high mortality, increased risk of cardiovascular events, and initiation of dialysis.

AMERICAN JOURNAL OF KIDNEY DISEASES (2022)

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Review Urology & Nephrology

Can Novel Potassium Binders Liberate People with Chronic Kidney Disease from the Low-Potassium Diet? A Cautionary Tale

David E. St-Jules et al.

Summary: The advent of new potassium binders is a significant breakthrough in managing hyperkalemia for people with CKD. These medications not only directly manage hyperkalemia but also have the potential to transition patients to a healthier eating pattern. However, the effectiveness of potassium binders in protecting against hyperkalemia caused by excessive dietary potassium intake is still uncertain.

CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY (2022)

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Article Urology & Nephrology

Stopping versus continuing renin-angiotensin-system inhibitors after acute kidney injury and adverse clinical outcomes: an observational study from routine care data

Roemer J. Janse et al.

Summary: Stopping RASi use after acute kidney injury is associated with similar risk of recurrent AKI but higher risk of death, myocardial infarction, and stroke.

CLINICAL KIDNEY JOURNAL (2022)

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Article Medicine, General & Internal

Assessment of Patiromer Monotherapy for Hyperkalemia in an Acute Care Setting

Katherine E. Di Palo et al.

Summary: Patiromer can be used to reduce serum potassium levels in patients with acute hyperkalemia, with a low incidence of hypokalemia.

JAMA NETWORK OPEN (2022)

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Article Medicine, Research & Experimental

Cost-Effectiveness of Treating Patients with Chronic Kidney Disease and Prior Hyperkalemia with Renin-Angiotensin-Aldosterone System Inhibitor and Patiromer: A Swiss Public Healthcare Perspective

Barbara Fischer et al.

Summary: Patiromer used for the treatment of CKD reduces hyperkalemia recurrence leading to improved patient care and substantial cost offsets for the Swiss healthcare system.

ADVANCES IN THERAPY (2022)

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Review Cardiac & Cardiovascular Systems

Compounding Benefits of Cholesterol-Lowering Therapy for the Reduction of Major Cardiovascular Events: Systematic Review and Meta-Analysis

Nelson Wang et al.

Summary: The aim of this study was to evaluate the relationship between lipid-lowering drug exposure time and relative risk reduction of major cardiovascular events in randomized clinical trials. The results showed that the relative risk reduction of major vascular events associated with lowering LDL-C increased with longer durations of treatment.

CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES (2022)

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Article Cardiac & Cardiovascular Systems

Risk of Hospitalization for Heart Failure in Patients With Hyperkalemia Treated With Sodium Zirconium Cyclosilicate Versus Patiromer

Min Zhuo et al.

Summary: This study aimed to investigate whether there is a difference in the risk of hospitalization for heart failure (HHF) between the initiation of sodium zirconium cyclosilicate (SZC) and patiromer for the treatment of hyperkalemia. The results from the matched analysis showed that the use of SZC was associated with a numerically higher risk of HHF compared to patiromer, but this difference did not reach statistical significance.

JOURNAL OF CARDIAC FAILURE (2022)

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Article Urology & Nephrology

Comparative efficacy of patiromer and sodium polystyrene sulfonate on potassium levels in chronic haemodialysis patients: a randomized crossover trial

David A. Jaques et al.

Summary: Both patiromer and sodium polystyrene sulfonate are effective in reducing potassium levels in chronic hemodialysis patients. However, at the tested doses, sodium polystyrene sulfonate was significantly more effective in doing so compared to patiromer, despite lower tolerability and compliance.

CLINICAL KIDNEY JOURNAL (2022)

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Article Cardiac & Cardiovascular Systems

Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial

Javed Butler et al.

Summary: The study found that patiromer can significantly lower serum potassium levels and enable specified target doses of RAASi in patients with heart failure and reduced ejection fraction, reducing the risk of hyperkalemia.

EUROPEAN HEART JOURNAL (2022)

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Editorial Material Cardiac & Cardiovascular Systems

Potassium binders for patients with heart failure? The real enlightenment of the DIAMOND trial

Milton Packer

EUROPEAN HEART JOURNAL (2022)

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Article Pharmacology & Pharmacy

Efficacy and safety of potassium binders in the treatment of patients with chronic kidney disease and hyperkalemia

Lingqiu Dong et al.

Summary: This systematic review and network meta-analysis compared the efficacy and safety of four potassium binders. The results showed that all four medications had promising effect in reducing potassium levels, but each had its own advantages and disadvantages. The selection of medication should be based on the clinical situation of the patient.

EUROPEAN JOURNAL OF PHARMACOLOGY (2022)

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Review Health Care Sciences & Services

Clinical Efficacy, Safety, Tolerability, and Real-World Data of Patiromer for the Treatment of Hyperkalemia

Gates Colbert et al.

Summary: Hyperkalemia remains a difficult consequence for patients with chronic kidney disease, heart failure, and diabetes. The introduction of the novel oral potassium binder patiromer has made it easier to control hyperkalemia, with proven efficacy and safety. This article discusses the potential improvements in disease outcomes by combining patiromer with RAASi and highlights upcoming trials.

DRUG HEALTHCARE AND PATIENT SAFETY (2022)

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Article Economics

The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland

Thomas Ward et al.

Summary: This study demonstrates the economic justification for reimbursing patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure in Ireland. Patiromer was found to improve life expectancy and quality-adjusted life expectancy while incurring marginal additional costs compared to standard care.

PHARMACOECONOMICS-OPEN (2022)

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Article Urology & Nephrology

Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)

Ian H. de Boer et al.

KIDNEY INTERNATIONAL (2022)

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Article Medicine, General & Internal

Real-world evaluation of patiromer utilization and its effects on serum potassium in veterans with end stage kidney disease

Derek Pinnell et al.

Summary: This study describes the utilization of Patiniromer in ESKD patients and its association with changes in serum K+ levels. Most patients discontinued their first Patiniromer treatment within 30 days, but approximately 20% initiated a second treatment episode after the follow-up period. Average serum K+ levels in ESKD patients were consistently reduced during follow-up.

MEDICINE (2022)

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Article Pharmacology & Pharmacy

Safety and Tolerability of the Potassium Binder Patiromer From a Global Pharmacovigilance Database Collected Over 4 Years Compared with Data from the Clinical Trial Program

Patrick Rossignol et al.

Summary: Global pharmacovigilance data over 4 years confirmed that the tolerability and safety of patiromer in clinical practice is predictable and consistent with clinical trial data, with no evidence of any new safety signals to date.

DRUGS-REAL WORLD OUTCOMES (2021)

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Review Cardiac & Cardiovascular Systems

Effects and Safety of a Novel Oral Potassium-Lowering Drug-Sodium Zirconium Cyclosilicate for the Treatment of Hyperkalemia: a Systematic Review and Meta-Analysis

Yaru Zhang et al.

Summary: Oral sodium zirconium cyclosilicate (SZC) effectively reduces serum potassium levels in patients with hyperkalemia within 48 hours, and continued use helps in long-term potassium control, showing a favorable safety profile.

CARDIOVASCULAR DRUGS AND THERAPY (2021)

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Article Transplantation

Adverse gastrointestinal events with sodium polystyrene sulphonate and calcium polystyrene sulphonate use in dialysis patients: a nationwide registry study

Joao Pedro Ferreira et al.

Summary: A large-scale nationwide study using data from the French National Registry and hospital discharge database found that the use of sodium polystyrene sulphonate (SPS) and calcium polystyrene sulphonate (CPS) in dialysis patients did not significantly increase the risk of adverse gastrointestinal events. The occurrence of adverse events remained low over a follow-up period of up to 5 years.

NEPHROLOGY DIALYSIS TRANSPLANTATION (2021)

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Article Cardiac & Cardiovascular Systems

Stopping mineralocorticoid receptor antagonists after hyperkalaemia: trial emulation in data from routine care

Marco Trevisan et al.

Summary: Stopping mineralocorticoid receptor antagonists after an episode of hyperkalaemia was associated with a reduced risk of recurrent hyperkalaemia but a higher risk of death or cardiovascular events. Recurrent hyperkalaemia was common in either strategy.

EUROPEAN JOURNAL OF HEART FAILURE (2021)

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Article Transplantation