Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba.
Chronic Disease Innovation Centre, Seven Oaks General Hospital.
Curr Opin Nephrol Hypertens. 2019 May;28(3):238-244. doi: 10.1097/MNH.0000000000000500.
Although renin-angiotensin aldosterone system (RAAS) inhibitors have become the mainstay treatment for patients with chronic diseases, hyperkalemia is a major contributory deterrent to their use in patients with chronic kidney disease (CKD) and heart failure. For the first time in 50 years, two new therapies (patiromer and ZS-9) have recently emerged for the concomitant treatment of hyperkalemia in these patients. The objective of this review is to discuss the efficacy and safety of these new agents.
Patiromer effectively reduces serum potassium in patients with CKD and heart failure, even with the concomitant use of RAAS inhibitors. The most common adverse events in clinical trials were gastrointestinal events. ZS-9 (Lokelma) rapidly reduces serum potassium levels and to a greater magnitude, and has a role in the acute management of hyperkalemia. Despite having more adverse events than patiromer, ZS-9 is overall well tolerated.
These new therapies show promising results for the chronic management of hyperkalemia, whilst also potentially allowing for the concomitant use of RAAS inhibitors at optimal doses. More research is needed to examine the benefits of continuation of RAAS inhibitors after an episode of hyperkalemia in patients with CKD and heart failure.
尽管肾素-血管紧张素-醛固酮系统（RAAS）抑制剂已成为治疗慢性疾病患者的主要方法，但高钾血症是其在慢性肾脏病（CKD）和心力衰竭患者中应用的主要障碍。近 50 年来，首次出现了两种新的治疗方法（聚对电解质和 ZS-9），可同时用于治疗这些患者的高钾血症。本综述的目的是讨论这些新药物的疗效和安全性。
聚对电解质可有效降低 CKD 和心力衰竭患者的血清钾水平，即使同时使用 RAAS 抑制剂也是如此。临床试验中最常见的不良事件是胃肠道事件。ZS-9（Lokelma）可迅速降低血清钾水平，且降低幅度更大，在高钾血症的急性治疗中有一定作用。尽管 ZS-9 的不良反应比聚对电解质更多，但总体上耐受性良好。
这些新的治疗方法为慢性高钾血症的管理提供了有前景的结果，同时还可能允许在 CKD 和心力衰竭患者中以最佳剂量同时使用 RAAS 抑制剂。需要进一步研究以评估在 CKD 和心力衰竭患者发生高钾血症后继续使用 RAAS 抑制剂的益处。
