Any News in Potassium Management?

Abstract

Cardiovascular disorders are the leading cause of death in dialysis patients, with 27% of all deaths attributable to arrhythmic mechanisms that are at least partly due to variations in serum potassium levels. Recently, Karaboyas et al compared the two most common dialysate prescriptions (2 vs 3 mEq/L) in terms of the associated risk of death and arrhythmia. No meaningful differences were observed in mortality and arrhythmia outcomes. However, a serum potassium level higher than 5.6 mEq/L was associated with higher mortality and a higher arrhythmia risk. Moreover, there was a direct, albeit small, association with +0.09 mEq/L serum potassium and every +1 mEq/L dialysate potassium, suggesting the utility of strategies other than altering the dialysate potassium concentration in order to control potassium levels. Two new potassium-binding drugs are now under evaluation which hopefully will be found to have greater tolerability than the widely used sodium polystyrene sulfonate, which is associated with important gastrointestinal side effects. Patiromer was approved in the United States in 2015, while sodium zirconium cyclosilicate 9 could really be the most interesting molecule, considering its action in the higher gastrointestinal tract without any side effects. However, more studies are required, also in dialysis patients.