A 65-year-old man with CKD stage 4 (eGFR 22 mL/min/1.73m²), type 2 diabetes, and serum potassium of 5.8 mEq/L develops worsening hyperkalaemia despite dietary restriction and standard measures. He requires RAAS blockade for cardiorenal protection. According to current guidelines, which novel agent is preferred for managing chronic hyperkalaemia to enable continuation of RAAS blockade?
- A Sodium polystyrene sulphonate (SPS) as long-term therapy
- B Patiromer (calcium patiromer) ✓
- C Oral sodium bicarbonate alone
- D Calcium resonium indefinitely
Explanation
Patiromer (calcium patiromer) and sodium zirconium cyclosilicate (SZC/ZS-9) are novel potassium-binding agents approved for chronic management of hyperkalaemia, enabling continuation of life-saving RAAS blockade in CKD and heart failure. Unlike sodium polystyrene sulphonate (SPS/Kayexalate), patiromer has proven efficacy and safety data in randomised trials (OPAL-HK trial) and lacks the intestinal necrosis risk associated with SPS. Patiromer binds potassium in exchange for calcium in the gut. Sodium bicarbonate addresses acidosis-driven hyperkalaemia but is insufficient as sole therapy. Calcium resonium is an older SPS equivalent without well-established long-term safety profile.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.