Emerging treatments
Potassium binders
Specifically for patients with hyperkalemic distal RTA (type IV), there are newer potassium binders that can be helpful in mitigating hyperkalemia 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 hypercalcemia. 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 mEq/L during the first 8 days of treatment in patients with eGFR <30 mL/min/1.73 m², rising to 1.22 mEq/L by day 365 of treatment; these figures were 0.92 mEq/L and 0.56 mEq/L, respectively, for patients with eGFR ≥30 mL/min/1.73 m².[149]
Use of this content is subject to our disclaimer