Hyperkalemia in heart failure

Hyperkalemia is increasingly prevalent in the heart failure population as more people live with heart failure and comorbid conditions such as diabetes and chronic kidney disease. Furthermore, renin–angiotensin–aldosterone (RAAS) inhibitors are a key component of clinical therapy in these populations. Until now, we have not had any reliable or tolerable therapies for treatment of hyperkalemia resulting in inability to implement or achieve target doses of RAAS inhibition. This review will focus on two new therapies for hyperkalemia: patiromer and sodium zirconium cyclosilicate (SZC). RECENT FINDINGS: Patiromer and SZC have been studied in heart failure and both agents have demonstrated the ability to maintain normokalemia for extended periods of time with improved side effect profiles than existing potassium binders such as sodium polystyrene sulfate, though no direct comparisons have occurred. SZC has also shown promise in the treatment of acute hyperkalemia with its quick onset of action. SUMMARY: Patiromer and SZC will be useful adjuncts in the clinical care of heart failure patients with hyperkalemia. These agents will allow clinicians to maintain patients on RAAS inhibitors and uptitrate their guideline directed medical therapy to target doses without the additional concern for recurrent hyperkalemia and its untoward effects.