期刊
DRUGS
卷 81, 期 13, 页码 1467-1489出版社
ADIS INT LTD
DOI: 10.1007/s40265-021-01555-5
关键词
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资金
- FIS/Fondos FEDER [PI18/01366, PI18/00610, PI19/00588, PI19/00815, DTS18/00032]
- ERA-PerMedJTC2018 (KIDNEY ATTACK) [AC18/00064]
- PERSTIGAN [AC18/00071]
- ISCIII-RETIC (REDinREN) [RD016/0009]
- Sociedad Espanola de Nefrologia
- FRIAT
- Comunidad de Madrid en Biomedicina [B2017/BMD-3686 CIFRA2-CM]
- RHU Fight-HF
- French National Research Agency (ANR), second Investissements d'Avenir program [ANR-15-RHUS-0004]
- French PIA project Lorraine Universite d'Excellence [ANR-15-IDEX-04LUE]
- ANR FOCUS-MR [ANR-15-CE14-0032-01]
- ERA-CVD EXPERT [ANR-16-ECVD-0002-02]
- Contrat de Plan Etat Lorraine IT2MP
- FEDER Lorraine
Despite the increasing global mortality rate associated with chronic kidney disease, recent advancements in novel kidney protective therapies have shown efficacy in clinical trials, providing hope for improved treatment outcomes.
Despite recent therapeutic advances, chronic kidney disease (CKD) is one of the fastest growing global causes of death. This illustrates limitations of current therapeutic approaches and, potentially, unidentified knowledge gaps. For decades, renin-angiotensin-aldosterone system (RAAS) blockers have been the mainstay of therapy for CKD. However, they favor the development of hyperkalemia, which is already common in CKD patients due to the CKD-associated decrease in urinary potassium (K+) excretion and metabolic acidosis. Hyperkalemia may itself be life-threatening as it may trigger potentially lethal arrhythmia, and additionally may limit the prescription of RAAS blockers and lead to low-K+ diets associated to low dietary fiber intake. Indeed, hyperkalemia is associated with adverse kidney, cardiovascular, and survival outcomes. Recently, novel kidney protective therapies, ranging from sodium/glucose cotransporter 2 (SGLT2) inhibitors to new mineralocorticoid receptor antagonists have shown efficacy in clinical trials. Herein, we review K+ pathophysiology and the clinical impact and management of hyperkalemia considering these developments and the availability of the novel K+ binders patiromer and sodium zirconium cyclosilicate, recent results from clinical trials targeting metabolic acidosis (sodium bicarbonate, veverimer), and an increasing understanding of the role of the gut microbiota in health and disease.
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