Management of hyperkalemia during treatment with mineralocorticoid receptor blockers: findings from esaxerenone

Abstract

The nonsteroidal mineralocorticoid receptor (MR) blocker esaxerenone has demonstrated good antihypertensive activity in a variety of patients, including those with uncomplicated grade I-III hypertension, hypertension with moderate renal dysfunction, hypertension with type 2 diabetes mellitus with albuminuria, and hypertension associated with primary aldosteronism. Hyperkalemia has long been recognized as a potential side effect occurring during treatment with MR blockers, but there is a lack of understanding and guidance about the appropriate management of hyperkalemia during antihypertensive therapy with MR blockers, especially in regard to the newer agent esaxerenone. In this article, we first highlight risk factors for hyperkalemia, including advanced chronic kidney disease, diabetes mellitus, cardiovascular disease, age, and use of renin-angiotensin-aldosterone system inhibitors. Next, we examine approaches to prevention and management, including potassium monitoring, diet, and the use of appropriate therapeutic techniques. Finally, we summarize the currently available data for esaxerenone and hyperkalemia. Proper management of serum potassium is required to ensure safe clinical use of MR blockers, including awareness of at-risk patient groups, choosing appropriate dosages for therapy initiation and dosage titration, and monitoring of serum potassium during therapy. It is critical that physicians take such factors into consideration to optimize MR blocker therapy in patients with hypertension.

Keywords: Esaxerenone; Hyperkalemia management; Hypertension; Mineralocorticoid receptor blocker.

Fig. 1

Serum potassium levels over time according to treatment regimen. A Changes in serum potassium levels. B Changes in serum potassium from baseline. Black arrows indicate dose increases at weeks 4, 6, and 8: 2.5–5 mg for the J302 [27] study and 1.25–2.5 mg for the J305 (unpublished data) and J306 [26] studies. The gray arrow indicates dose increases at week 8: 2.5–5 mg for the J305 (unpublished data) and J306 [26] studies. Solid lines indicate dose periods, and dotted lines indicate follow-up (no treatment) periods