New data suggest that treatment with patiromer or sodium zirconium cyclosilicate for up to 8 weeks reduces plasma potassium levels in hyperkalaemic patients. If proven safe and effective for long-term use, these therapies might be administered together with intensive renin–angiotensin–aldosterone blockade to reduce adverse effects and renal and cardiovascular risk.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Change history
10 February 2015
In the version of this article that was initially published online, the withdrawal phase of the study by Weir et al. was incorrectly described as double-blind rather than single-blind and ZS-9 was incorrectly described as a nonabsorbable polymer rather than a high-specificity inorganic crystal. The errors have been corrected in the html and pdf versions of the article.
References
Roscioni, S. S., de Zeeuw, D., Bakker, S. J. & Lambers Heerspink, H. J. Management of hyperkalaemia consequent to mineralocorticoid-receptor antagonist therapy. Nat. Rev. Nephrol. 8, 691–699 (2012).
Sterns, R. H., Rojas, M., Bernstein, P. & Chennupati, S. Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective? J. Am. Soc. Nephrol. 5, 733–735 (2010).
Weir, M. R. et al. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N. Engl. J. Med. http://dx.doi.org/10.1056/NEJMoa1410853.
Packham, D. K. et al. Sodium zirconium cyclosilicate in hyperkalemia. N. Engl. J. Med. http://dx.doi.org/10.1056/NEJMoa1411487.
Kosiborod, M. et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA 312, 2223–2233 (2014).
Yusuf, S. et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 358, 1547–1559 (2008).
Parving, H. H. et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N. Engl. J. Med. 367, 2204–2213 (2012).
Fried, L. F. et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N. Engl. J. Med. 369, 1892–1903 (2013).
Lambers Heerspink, H. J. et al. The effect of ramipril and telmisartan on serum potassium and its association with cardiovascular and renal events: results from the ONTARGET trial. Eur. J. Prev. Cardiol. 3, 299–309 (2013).
Miao, Y. et al. Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. Diabetologia 54, 44–50 (2011).
Acknowledgements
We thank D. de Zeeuw (University Medical Center Groningen, Netherlands) for his assistance with this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
H.J.L.H. is a consultant for and has received honoraria (paid to his employer) from AbbVie, Astellas, Johnson & Johnson and Reata. S.S.R. declares no competing interests.
Rights and permissions
About this article
Cite this article
Roscioni, S., Heerspink, H. New nonabsorbable potassium-exchange resins in hyperkalaemia. Nat Rev Nephrol 11, 205–206 (2015). https://doi.org/10.1038/nrneph.2014.252
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrneph.2014.252