The new potassium binders patiromer and sodium zirconium cyclosilicate (ZS-9) appear to lower serum potassium levels with an acceptable safety profile in patients with comorbidities, according to a new systematic review discussed at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston.

Krishiv Ella, of Fort Bend ISD, Sugar Land, Texas, and Sankar Dass Navaneethan, MBBS, of Baylor College of Medicine in Houston, evaluated 6 clinical trials of 1756 patients (mean age 65) with chronic kidney disease, congestive heart failure, hypertension, or diabetes, assigned to receive patiromer, ZS-9, or placebo. Patiromer reduced serum potassium by 0.65 to 1.01 meq/L at 4 weeks, whereas ZS-9 reduced serum potassium by a similar magnitude at 48 hours (and up to 4 weeks in 1 study).

Patiromer recipients commonly reported constipation, hypomagnesemia, hypokalemia, and diarrhea, the investigators reported in a poster presentation. ZS-9 was associated with fewer gastrointestinal side effects and electrolyte abnormalities, but more ZS-9 than placebo recipients had edema.

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“Current clinical trial evidence demonstrate[s] the potassium lowering potential of newer therapeutic agents and their differential side effects,” the authors concluded.

Whether potassium-binding therapy reduces long-term risks of cardiovascular disease and death requires additional study.


Ella K, Navaneethan SD. Novel agents for treatment of hyperkalemia: A systematic review. Abstract presented at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston, May 8-12, 2019. Abstract 317.