Sarafidis Pantelis A, Georgianos Panagiotis I, Bakris George L
a 1 Aristotle University of Thessaloniki, Department of Nephrology, Hippokration Hospital , Thessaloniki, Greece.
b 2 Aristotle University of Thessaloniki, Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital , Thessaloniki, Greece.
Expert Opin Pharmacother. 2015;16(14):2205-15. doi: 10.1517/14656566.2015.1083977. Epub 2015 Sep 2.
Hyperkalemia is a frequent electrolyte disorder associated with life-threatening cardiac arrhythmias and sudden death. Patients prone to hyperkalemia have chronic kidney disease (CKD) either alone or in conjunction with diabetes or heart failure (HF). Although agents inhibiting the renin-angiotensin-aldosterone-system (RAAS) are currently the first-line treatments toward cardio- and nephroprotection, their administration often leads to potassium elevation in such patients and results in high rates of treatment discontinuation.
This article provides an overview of factors interfering with potassium homeostasis and discusses emerging potassium-lowering therapies for long-term management of hyperkalemia.
In recent randomized clinical studies, two new oral potassium-exchanging compounds, patiromer and sodium zirconium cyclosilicate, were shown to effectively normalize elevated serum potassium and chronically maintain potassium homeostasis in hyperkalemic patients treated with RAAS blockers. Both agents exhibit good tolerability and were not associated with serious adverse effects. Although additional research is required, these drugs are promising for lowering the risk of incident hyperkalemia associated with RAAS blockade use in people with diabetes or HF who have CKD. They also provide the opportunity to test whether patients who could not previously receive RAAS blockade may benefit from their cardio- and renoprotective effects.
高钾血症是一种常见的电解质紊乱，与危及生命的心律失常和猝死相关。易患高钾血症的患者单独患有慢性肾脏病（CKD），或合并糖尿病或心力衰竭（HF）。尽管目前抑制肾素-血管紧张素-醛固酮系统（RAAS）的药物是心脏和肾脏保护的一线治疗药物，但在这类患者中使用这些药物往往会导致血钾升高，并导致高停药率。
本文概述了干扰钾稳态的因素，并讨论了用于高钾血症长期管理的新兴降钾疗法。
在最近的随机临床研究中，两种新型口服钾交换化合物，帕替罗姆和环硅酸锆钠，在接受RAAS阻滞剂治疗的高钾血症患者中显示出能有效使升高的血清钾正常化并长期维持钾稳态。这两种药物均具有良好的耐受性，且未出现严重不良反应。尽管还需要进一步研究，但这些药物有望降低患有CKD的糖尿病或HF患者因使用RAAS阻滞剂而发生高钾血症的风险。它们还提供了一个机会来测试以前无法接受RAAS阻滞剂治疗的患者是否可能从其心脏和肾脏保护作用中获益。
