Arizona State University, Edson College, Phoenix, Arizona.
UCSF Medical Center, University of California San Francisco, San Francisco, California.
Curr Opin Nephrol Hypertens. 2021 Jan;30(1):27-37. doi: 10.1097/MNH.0000000000000657.
Medications used frequently after kidney transplantation, including calcineurin inhibitors, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers and antimicrobials, are considered the leading culprit for posttransplant hyperkalaemia in recipients with a well functioning allograft. Other risk factors include comorbidities such as diabetes, hypertension and heart failure; and consumption of a potassium-enriched diet. We review the mechanisms for hyperkalaemia following kidney transplantation that are addressed using nonpharmacological and pharmacological interventions. We also discuss emerging therapeutic approaches for the management of recurrent hyperkalaemia in solid organ transplantation, including newer potassium binding therapies.
Patiromer and sodium zirconium cyclosilicate are emerging potassium binders approved for the treatment of hyperkalaemia. Patiromer is a polymer that exchanges potassium for calcium ions. In contrast, sodium zirconium cyclosilicate is a nonpolymer compound that exchanges potassium for sodium and hydrogen ions. Both agents are efficacious in the treatment of chronic or recurrent hyperkalaemia and may result in fewer gastrointestinal side effects than older potassium binders such as sodium polystyrene sulfonate and calcium polystyrene sulfonate. Large-scale clinical studies have not been performed in kidney transplant patients. Patiromer may increase serum concentrations of tacrolimus, but not cyclosporine. Sodium zirconium cyclosilicate does not appear to compromise tacrolimus pharmacokinetics, although it may have a higher sodium burden.
Patiromer and sodium zirconium cyclosilicate may be well tolerated options to treat asymptomatic hyperkalaemia and have the potential to ease potassium dietary restrictions in kidney transplant patients by maintaining a plant-dominant, heart-healthy diet. Their efficacy, better tolerability and comparable cost with respect to previously available potassium binders make them an attractive therapeutic option in chronic hyperkalaemia following kidney transplantation.
肾移植后常使用的药物，包括钙调磷酸酶抑制剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂和抗生素，被认为是功能良好的同种异体移植物受者发生移植后高钾血症的主要原因。其他危险因素包括合并症，如糖尿病、高血压和心力衰竭；以及富含钾的饮食。我们综述了肾移植后发生高钾血症的机制，以及使用非药物和药物干预来解决这些机制。我们还讨论了实体器官移植中复发性高钾血症的新兴治疗方法，包括新型的钾结合治疗。
聚普瑞锌和硅酸锆钠是新兴的钾结合剂，已被批准用于治疗高钾血症。聚普瑞锌是一种聚合物，可将钾离子交换为钙离子。相比之下，硅酸锆钠是一种非聚合物化合物，可将钾离子交换为钠离子和氢离子。这两种药物在治疗慢性或复发性高钾血症方面都有效，并且可能比聚苯乙烯磺酸钠和钙聚苯乙烯磺酸钠等较老的钾结合剂引起更少的胃肠道副作用。尚未在肾移植患者中进行大规模临床研究。聚普瑞锌可能会增加他克莫司的血清浓度，但不会增加环孢素的浓度。硅酸锆钠似乎不会影响他克莫司的药代动力学，但它可能会增加钠的负担。
聚普瑞锌和硅酸锆钠可能是治疗无症状高钾血症的良好耐受选择，并且通过维持以植物为主、有益于心脏健康的饮食，可以减轻肾移植患者对钾的饮食限制。与以前可用的钾结合剂相比，它们的疗效、更好的耐受性和可比的成本使它们成为慢性肾移植后高钾血症的一种有吸引力的治疗选择。
