@article{e3010c01ff6b4962a1e8abdcf12e74a4,
title = "Pragmatic diagnostic and therapeutic algorithms to optimize new potassium binder use in cardiorenal disease",
abstract = "BACKGROUND: Pivotal randomized trials demonstrating efficacy, safety and good tolerance, of two new potassium binders (patiromer and sodium zirconium cyclosilicate) led to their recent approval. A major hurdle to the implementation of these potassium-binders is understanding how to integrate them safely and effectively into the long-term management of cardiovascular and kidney disease patients using renin angiotensin aldosterone system inhibitors (RAASi), the latter being prone to induce hyperkalaemia.METHODS: A multidisciplinary academic panel including nephrologists and cardiologists was convened to develop consensus therapeutic algorithm(s) aimed at optimizing the use of the two novel potassium binders (patiromer and sodium zirconium cyclosilicate) in stable adults who require treatment with RAASi and experience(d) hyperkalaemia in a non-emergent setting.RESULTS: Two dedicated pragmatic algorithms are proposed. The lowest intervention threshold (i.e. 5.1 mmol/L or greater) was the one used in the patiromer and sodium zirconium cyclosilicate) pivotal trials, both drugs being indicated to treat hyperkalaemia in a non -emergent setting. Acknowledging the heterogeneity across specialty guidelines in hyperkalaemia definition and thresholds to intervene when facing hyperkalaemia, we have been mindful to use soft language i.e. {"}it is to consider{"}, not necessarily {"}to do{"}.CONCLUSIONS: Providing the clinical community with pragmatic algorithms may help optimize the management of high-risk patients by avoiding the risks of both hyper and hypokalaemia and of suboptimal RAASi therapy.",
keywords = "Adult, Algorithms, Heart Diseases, Heart Failure, Humans, Hyperkalemia/diagnosis, Hypertension, Renal, Nephritis, Potassium, Renal Insufficiency, Chronic/drug therapy, Renin-Angiotensin System, Sodium zirconium cyclosilicate, Hyperkalaemia, Algorithm, Patiromer, Potassium binder",
author = "P Rossignol and J Silva-Cardoso and Kosiborod, {M N} and V Brandenburg and Cleland, {J G} and H Hadimeri and R Hullin and S Makela and D M{\"o}rtl and E Paoletti and C Pollock and L Vogt and M Jadoul and J Butler",
note = "Funding Information: PR reports consulting for Bayer, CinCor, G3P, Idorsia, and KBP; honoraria from Ablative Solutions, AstraZeneca, Bayer, Boehringer-Ingelheim, Corvidia, CVRx, Fresenius, Grunenthal, Novartis, Novo Nordisk, Relypsa Inc., a Vifor Pharma Group Company, Sanofi, Sequana Medical, Servier, Stealth Peptides, and Vifor Fresenius Medical Care Renal Pharma; Cofounder: CardioRenal. JSC has received speaker and consultant fees, or advisory board participation fees, or investigational grants from Abbott, AstraZeneca Pharmaceuticals, Bial, Boehringer Ingelheim, Menarini, Merck Serono, Merck Sharp & Dohme, Novartis, Orion, Pfizer, Sanofi, Servier, and Vifor Pharma outside of this work. MK: Research grants: AstraZeneca, Boehringer Ingelheim. Consultant: AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, Eli Lilly, Janssen, Merck (Diabetes and Cardiovascular), Novo Nordisk, Sanofi, Vifor. VB reports speaker fees for Astra,Zeneca and Speaker/consultancy-fees from Vifor Pharma.JGC: reports receiving funding fro research and personal honoraria for advisory boards and lectures from Vifor Pharma. HH reports consulting and participation in advisory board for AstraZeneca, Vifor Pharma Nordiska AB, Otsuka. RH reports consultancy/speaker fees from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Vifor Fresenius Medical, Novartis, cti vascular, and a collaborative clinical reserch grant with Astra Zeneca. SM: speaker fees or advisory board participation fees from Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, and Vifor Pharma. DM is a consultant for or received speakers fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Novartis, Vifor. EP received fees from, and acts as consultant for: AstraZeneca, Bayer, Vifor, Novartis, Fresenius, Astellas. CP is a consultant for or received speaker fees from Astra Zeneca, Boehringer Ingelheim, Vifor, Chinook and Otsuka. LV: consultant for Astrazeneca, Bayer, Sanofi Genzyme and Vifor Pharma Group. MJ has received unrestricted research grants from Amgen and Astra-Zeneca and consultancy/speaker fees from Astellas, Astra-Zeneca, Bayer, Boehringer-Ingelheim, Mundipharma, Vifor Fresenius Medical Care Renal Pharma and Fresenius Medical Care Asia Pacific. JB is a consultant for Abbott, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, CVRx, Eli Lilly, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Sequana, StealthPeptide, Vifor. Publisher Copyright: {\textcopyright} 2022 Elsevier Ltd",
year = "2022",
month = aug,
doi = "10.1016/j.phrs.2022.106277",
language = "English",
volume = "182",
pages = "106277",
journal = "Pharmacological Research",
issn = "1043-6618",
publisher = "Academic Press Inc.",
}