Potassium Binding for Conservative and Preservative Management of Chronic Kidney Disease

Deborah J. Clegg; Biff F. Palmer


Curr Opin Nephrol Hypertens. 2020;29(1):29-38. 

In This Article

Treatment of Chronic Hyperkalemia

The treatment of hyperkalemia varies according to the presence or absence of signs and symptoms associated with hyperkalemia, the severity and rate of rise in plasma K+, and the underlying cause. Emergent treatment for hyperkalemia begins with stabilization of the myocardium followed by shifting K+ into cells. Once stabilized, treatments focuses on lowering total body K+ content by eliminating sources of K+, such as supplements (to include those found in salt substitutes and some herbal medications), discontinue prescribed or over-the-counter drugs known to interfere in kidney K+ excretion (nonsteroidal anti-inflammatory drugs), ensure effective diuretic therapy, and correct metabolic acidosis if present.[6] Management of nonemergent hyperkalemia includes the use of loop or thiazide diuretics, modification of RAASi therapy and removal of other offending medications, dietary modifications, dialysis (as needed), and the use of K+-binding agents.[24–26]

Below, we will discuss the use of binders, such as sodium polystyrene sulfonate (SPS) and two newer agents and highlight the risks and benefits of each. Although dialysis is a reliable and effective option to treat hyperkalemia, it is a procedure with invasiveness especially in nondialysis-dependent CKD patients who do not have dialysis access. K+-binders are one of the most effective options to remove K+ as these agents have a relatively rapid onset of action, are noninvasive, and widely available.