Hyperkalemia in Chronic Kidney Disease in the New Era of Kidney Protection Therapies.
Jose Manuel ValdivielsoOlga BalafaRobert EkartCharles J FerroFrancesca MallamaciPatrick B MarkPatrick RossignolPantelis SarafidisLucia Del VecchioAlberto OrtizPublished in: Drugs (2021)
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.
Keyphrases
- chronic kidney disease
- end stage renal disease
- angiotensin converting enzyme
- clinical trial
- angiotensin ii
- healthcare
- public health
- mental health
- peritoneal dialysis
- emergency department
- weight loss
- risk assessment
- social media
- weight gain
- prognostic factors
- health information
- ejection fraction
- drug delivery
- phase iii
- drug induced
- human health