Utilization of Potassium Binders for the Management of Hyperkalemia in Chronic Kidney Disease: A Position Statement by US Nephrologists

Abstract

Two potassium (K⁺) binders-patiromer sorbitex calcium and sodium zirconium cyclosilicate-are recommended by international guidelines for the management of hyperkalemia. There is, however, no universally accepted best practice for how to appropriately utilize K⁺ binders in the long-term clinical management of CKD. A panel of eight US-based nephrologists convened in October 2022 to develop a consensus statement regarding utilizing K⁺ binders in clinical practice to help manage patients with nonemergent, persistent/recurrent hyperkalemia in CKD. Consensus was reached on the following topics: (1) identifying risk factors for hyperkalemia; (2) serum K⁺ monitoring before and during K⁺ binder use; (3) utilizing K⁺ binders in patients receiving renin-angiotensin-aldosterone system inhibitors and dialysis; and (4) when to initiate K⁺ binders and their duration of use. These consensus statements for the use of K⁺ binders may assist the nephrology community in optimizing management of hyperkalemia in patients across the spectrum of CKD.

Keywords: Chronic kidney disease; Consensus; Hyperkalemia; Potassium binder; Sodium zirconium cyclosilicate.