Esposito Pasquale, Conti Novella Evelina, Falqui Valeria, Cipriani Leda, Picciotto Daniela, Costigliolo Francesca, Garibotto Giacomo, Saio Michela, Viazzi Francesca
Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 16132 Genoa, Italy.
J Clin Med. 2020 Jul 22;9(8):2337. doi: 10.3390/jcm9082337.
Hyperkalemia may cause life-threatening cardiac and neuromuscular alterations, and it is associated with high mortality rates. Its treatment includes a multifaceted approach, guided by potassium levels and clinical presentation. In general, treatment of hyperkalemia may be directed towards stabilizing cell membrane potential, promoting transcellular potassium shift and lowering total K body content. The latter can be obtained by dialysis, or by increasing potassium elimination by urine or the gastrointestinal tract. Until recently, the only therapeutic option for increasing fecal K excretion was represented by the cation-exchanging resin sodium polystyrene sulfonate. However, despite its common use, the efficacy of this drug has been poorly studied in controlled studies, and concerns about its safety have been reported. Interestingly, new drugs, namely patiromer and sodium zirconium cyclosilicate, have been developed to treat hyperkalemia by increasing gastrointestinal potassium elimination. These medications have proved their efficacy and safety in large clinical trials, involving subjects at high risk of hyperkalemia, such as patients with heart failure and chronic kidney disease. In this review, we discuss the mechanisms of action and the updated data of patiromer and sodium zirconium cyclosilicate, considering that the availability of these new treatment options offers the possibility of improving the management of both acute and chronic hyperkalemia.
高钾血症可能导致危及生命的心脏和神经肌肉改变，且与高死亡率相关。其治疗包括多方面的方法，以血钾水平和临床表现为指导。一般来说，高钾血症的治疗可针对稳定细胞膜电位、促进钾离子向细胞内转移以及降低体内总钾含量。后者可通过透析，或通过增加尿液或胃肠道的钾排泄来实现。直到最近，增加粪便钾排泄的唯一治疗选择是阳离子交换树脂聚苯乙烯磺酸钠。然而，尽管其使用普遍，但该药物的疗效在对照研究中研究较少，且已有关于其安全性的担忧报道。有趣的是，已开发出新药，即帕替罗姆和环硅酸锆钠，通过增加胃肠道钾排泄来治疗高钾血症。这些药物在涉及高钾血症高危受试者（如心力衰竭和慢性肾脏病患者）的大型临床试验中已证明了其疗效和安全性。在本综述中，鉴于这些新治疗选择的可用性为改善急性和慢性高钾血症的管理提供了可能性，我们讨论了帕替罗姆和环硅酸锆钠的作用机制及最新数据。
