Emerging treatments
Potassium binders
Specifically for patients with hyperkalaemic distal RTA (type IV), there are newer potassium binders that can be helpful in mitigating hyperkalaemia and acidosis. Patiromer is a polymeric cation exchange resin that binds potassium in exchange of calcium ions.[147] Due to this mechanism, patients on patiromer should be monitored for hypercalcaemia. Sodium zirconium cyclosilicate (SZC) is a non-polymeric, selective potassium binder, which entraps potassium and ammonium ions in exchange for hydrogen and sodium ions.[148] It can therefore lead to sodium retention and should be used cautiously in heart failure and volume overloaded patients. A phase 3 single arm, open label study of SZC demonstrated a mean increase in serum bicarbonate of 1.02 mmol/L (1.02 mEq/L) during the first 8 days of treatment in patients with eGFR <30 mL/min/1.73 m², rising to 1.22 mmol/L (1.22 mEq/L) by day 365 of treatment; these figures were 0.92 mmol/L (0.92 mEq/L) and 0.56 mmol/L (0.56 mEq/L), respectively, for patients with eGFR ≥30 mL/min/1.73 m².[149]
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