Discussing the Chronic Treatment Options for Hyperkalemia

EP: 1.Risk Factors, Epidemiology, and Patient Burden Associated With Hyperkalemia

EP: 2.Exploring the Underdiagnosis of Hyperkalemia

EP: 3.Acute and Chronic Management of Hyperkalemia

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EP: 4.Discussing the Chronic Treatment Options for Hyperkalemia

This content is a production of Drug Topics; this Pharmacist Video is supported by funding from AstraZeneca. AstraZeneca was not involved in the creation of the content for this Video.

The treatment landscape for chronic hyperkalemia has evolved significantly with the introduction of novel potassium binders such as patiromer and sodium zirconium cyclosilicate (SZC). These therapies represent a major improvement over older agents like sodium polystyrene sulfonate (SPS), which was historically approved with limited clinical evidence and has since raised serious safety concerns. SPS is associated with gastrointestinal complications, including erosions and even perforation, especially in sorbitol-containing formulations. Its variable efficacy and unpredictable patient response further limit its reliability. In contrast, patiromer and SZC were developed with modern clinical standards in mind, offering more consistent potassium reduction and an improved safety profile.

Each of the new agents offers distinct characteristics that help guide therapy selection. Patiromer is a calcium-based exchange resin that gradually reduces potassium over several hours, typically peaking in effect within 24 to 48 hours. It can interfere with the absorption of other oral medications, requiring careful dosing separation. SZC, on the other hand, is a sodium-based binder that acts more quickly, often lowering potassium within 1 to 2 hours, making it preferable in situations requiring rapid correction. However, the sodium content in SZC can pose a risk for fluid retention, particularly in patients with heart failure or volume overload, and should be used cautiously in those populations.

Choosing the most appropriate binder often depends on clinical context, urgency of treatment, comorbid conditions, and logistical factors like formulary access or insurance coverage. While both agents have demonstrated effectiveness in managing chronic hyperkalemia and allowing continuation of essential therapies such as renin-angiotensin-aldosterone system inhibitors, pharmacists play a crucial role in individualizing treatment plans. By understanding the pharmacologic nuances and patient-specific risks, clinicians can better balance hyperkalemia management with optimal use of cardioprotective medications, improving long-term outcomes in high-risk populations.