Pragmatic diagnostic and therapeutic algorithms to optimize new potassium binder use in cardiorenal disease

Rossignol, P. et al. (2022) Pragmatic diagnostic and therapeutic algorithms to optimize new potassium binder use in cardiorenal disease. Pharmacological Research, 182, 106277. (doi: 10.1016/j.phrs.2022.106277) (PMID:35662631)

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Abstract

Background: Pivotal randomized trials demonstrating efficacy, safety and good tolerance, of two new potassium binders (patiromer and sodium zirconium cyclosilicate) led to their recent approval. A major hurdle to the implementation of these potassium-binders is understanding how to integrate them safely and effectively into the long-term management of cardiovascular and kidney disease patients using renin angiotensin aldosterone system inhibitors (RAASi), the latter being prone to induce hyperkalaemia. Methods: A multidisciplinary academic panel including nephrologists and cardiologists was convened to develop consensus therapeutic algorithm(s) aimed at optimizing the use of the two novel potassium binders (patiromer and sodium zirconium cyclosilicate) in stable adults who require treatment with RAASi and experience(d) hyperkalaemia in a non-emergent setting. Results: Two dedicated pragmatic algorithms are proposed. The lowest intervention threshold (i.e. 5.1 mmol/L or greater) was the one used in the patiromer and sodium zirconium cyclosilicate) pivotal trials, both drugs being indicated to treat hyperkalaemia in a non -emergent setting. Acknowledging the heterogeneity across specialty guidelines in hyperkalaemia definition and thresholds to intervene when facing hyperkalaemia, we have been mindful to use soft language i.e. “it is to consider”, not necessarily “to do”. Conclusions: Providing the clinical community with pragmatic algorithms may help optimize the management of high-risk patients by avoiding the risks of both hyper and hypokalaemia and of suboptimal RAASi therapy.

Item Type:Articles (Editorial)
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Rossignol, P., Silva-Cardoso, J., Kosiborod, M.N., Brandenburg, V., Cleland, J.G., Hadimeri, H., Hullin, R., Makela, S., Mörtl, D., Paoletti, E., Pollock, C., Vogt, L., Jadoul, M., and Butler, J.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Pharmacological Research
Publisher:Elsevier
ISSN:1043-6618
ISSN (Online):1096-1186
Published Online:01 June 2022
Copyright Holders:Copyright © 2022 Elsevier Ltd.
First Published:First published in Pharmacological Research 182: 106277
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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