Complications and management of hyperkalemia: implications for the use of the novel cation exchangers zirconium cyclosilicate and patiromer

Hyperkalemia is a serious and common clinical condition associated with increased morbidity and death. The risk of hyperkalemia is increased in patients with chronic kidney disease, diabetes, conditions with impaired distal renal sodium delivery and those on renin–angiotensin–aldosterone system (RAAS) blockade. RAAS blockade has been shown to slow progression of proteinuric kidney disease and reduce mortality in patients with systolic heart failure. Yet delivery of optimum RAAS blockade is frequently limited by development of hyperkalemia. Current treatment for hyperkalemia is suboptimal and few options exist for long-term control of hyperkalemia. In this review article, we explore two new oral nonabsorbable cation exchangers, zirconium cyclosilicate (ZS-9) and patiromer that bind potassium for the treatment of hyperkalemia.