Utilization of Potassium Binders for the Management of Hyperkalemia in Chronic Kidney Disease: A Position Statement by US Nephrologists

Adv Kidney Dis Health. 2024 Nov;31(6):514-522. doi: 10.1053/j.akdh.2024.08.003.

Abstract

Two potassium (K+) binders-patiromer sorbitex calcium and sodium zirconium cyclosilicate-are recommended by international guidelines for the management of hyperkalemia. There is, however, no universally accepted best practice for how to appropriately utilize K+ binders in the long-term clinical management of CKD. A panel of eight US-based nephrologists convened in October 2022 to develop a consensus statement regarding utilizing K+ binders in clinical practice to help manage patients with nonemergent, persistent/recurrent hyperkalemia in CKD. Consensus was reached on the following topics: (1) identifying risk factors for hyperkalemia; (2) serum K+ monitoring before and during K+ binder use; (3) utilizing K+ binders in patients receiving renin-angiotensin-aldosterone system inhibitors and dialysis; and (4) when to initiate K+ binders and their duration of use. These consensus statements for the use of K+ binders may assist the nephrology community in optimizing management of hyperkalemia in patients across the spectrum of CKD.

Keywords: Chronic kidney disease; Consensus; Hyperkalemia; Potassium binder; Sodium zirconium cyclosilicate.

Publication types

  • Consensus Development Conference

MeSH terms

  • Chelating Agents / therapeutic use
  • Humans
  • Hyperkalemia* / drug therapy
  • Polymers / therapeutic use
  • Potassium* / blood
  • Renal Dialysis / adverse effects
  • Renal Insufficiency, Chronic* / complications
  • Renal Insufficiency, Chronic* / drug therapy
  • Renin-Angiotensin System / drug effects
  • Silicates* / therapeutic use
  • United States

Substances

  • Chelating Agents
  • patiromer
  • Polymers
  • Potassium
  • Silicates
  • sodium zirconium cyclosilicate