CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.
Department of Medicine, Division of Nephrology, UCLA-Health, USA.
Expert Rev Clin Pharmacol. 2021 Sep;14(9):1055-1064. doi: 10.1080/17512433.2021.1932460. Epub 2021 Jul 6.
Hyperkalemia is a common finding in patients with advanced kidney disease for multiple reasons. Renin-Angiotensin-Aldosterone-System Inhibitors (RAASi) that are indicated for slowing down progression of kidney disease are often associated with hyperkalemia which becomes a limiting factor in their use and titration to the maximum dose. Having a safe, effective, tolerable, and affordable potassium binder can help optimize RAAS inhibition in the setting of kidney disease.
Although sodium polystyrene sulfonate has been a mainstay of acute management of hyperkalemia for decades, evidence regarding its efficacy is limited, and its chronic use is not routinely recommended for concerns regarding toxicity. The concern of gastrointestinal (GI) adverse effects with sodium polystyrene sulfonate has spurred the development of alternatives. Sodium zirconium cyclosilicate (SZC) is a promising agent that selectively binds potassium in the gut and eliminates it, while being safe for chronic use based on 1 year of data. Even though we do not have head-to-head studies among the three currently available binders, SZC stands out in rapidity of onset and efficacy.
In this review, we summarize the general management of hyperkalemia, including new agents. We review the pre-clinical and clinical data relating to sodium zirconium cyclosilicate.
由于多种原因，晚期肾病患者常出现高钾血症。肾素-血管紧张素-醛固酮系统抑制剂（RAASi）被用于减缓肾病进展，但常与高钾血症相关，这限制了其使用和最大剂量滴定。安全、有效、耐受且价格合理的钾结合剂有助于优化肾病患者的 RAAS 抑制作用。
尽管聚苯乙烯磺酸纳数十年来一直是急性高钾血症管理的主要药物，但关于其疗效的证据有限，且出于毒性方面的考虑，其慢性使用并不常规推荐。人们担心聚苯乙烯磺酸纳会引起胃肠道（GI）不良反应，这促使人们开发了替代品。硅酸锆酸钠（SZC）是一种很有前途的药物，它可以选择性地在肠道中结合并排出钾，基于 1 年的数据，SZC 可安全用于慢性使用。尽管我们目前还没有三种可用结合剂之间的头对头研究，但 SZC 在起效速度和疗效方面表现突出。
在这篇综述中，我们总结了高钾血症的一般治疗方法，包括新的药物。我们回顾了与硅酸锆酸钠有关的临床前和临床数据。
