New potassium binders: we need them - we do not need them

Clinical Kidney Journal

Abstract

Abstract New potassium binders may facilitate contemporary chronic kidney disease care by controlling hyperkalemia and thereby facilitating the continued use of kidney- and cardioprotective therapies, particularly renin-angiotensin-aldosterone system inhibitors. The opposing view is that sodium polystyrene sulfonate remains effective, familiar, inexpensive, and often well tolerated, while direct comparative evidence has not yet shown clinically meaningful superiority of newer binders. This debate weighs clinical utility, comparative efficacy, safety, and cost, concluding that new binders are valuable options but that their routine replacement of established low-dose sodium polystyrene sulfonate and the need for potassium binders beyond optimized diuretic therapy, acidosis control, diet etc. requires stronger comparative evidence.

Authors 4

1. Luca De Nicola corresponding
   Affiliation as printed

   Nephrology and Dialysis Unit, Dept. Advanced Medical and Surgical Sciences, University L. Vanvitelli ,

2. Marie Evans corresponding

   Karolinska University Hospital

   Affiliation as printed

   Karolinska Institutet and Karolinska University Hospital Department of Clinical Intervention and Technology, ,

3. Juergen Floege Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital Department of Nephrology and Immunology, , Aachen ,

4. Carmine Zoccali

   Biogem · Renal Research Institute

   Affiliation as printed

   Associazione Ipertensione, Nefrologia, Trapianto Renale (IPNET) , Reggio Cal ,

   Institute of Biology and Molecular Genetics , Ariano Irpino ,

   Renal Research Institute , NY ,