新型鉀離子結合劑 Lokelma 的應用
Abstract List
20 Sep 2026
15:00
15:30
Kuang-Yu WeiTaiwan
Speaker
新型鉀離子結合劑 Lokelma 的應用Over the past decade, treatment of chronic kidney disease (CKD) and heart failure has evolved towards an integrated approach to cardiorenal protection that includes renin–angiotensin–aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists (MRAs), sodium–glucose cotransporter 2 (SGLT2) inhibitors and more individualized strategies for dietary potassium intake. RAAS inhibitors remain a cornerstone of treatment, and clinical trials have generally demonstrated the greatest benefits when these drugs are prescribed at maximally tolerated doses. However, the risk of hyperkalaemia frequently limits their initiation, dose optimization and continued use, thereby reducing the potential kidney and cardiovascular benefits of treatment.
Hyperkalaemia should therefore be regarded as a manageable complication of cardiorenal therapy rather than an automatic indication to reduce or discontinue RAAS inhibition. Contemporary management includes correction of reversible causes together with individualized dietary interventions, diuretics, SGLT2 inhibitors and potassium-lowering therapies. The aim of these strategies is not merely to achieve a transient reduction in blood potassium, but to enable patients to initiate and maintain guideline-directed treatment. When further inhibition of the RAAS pathway is indicated, an MRA can be added to a maximally tolerated angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. In individuals at increased risk of hyperkalemia, the non-steroidal MRA may offer a more favorable potassium profile than steroidal MRAs.
Beyond their established cardiorenal benefits, SGLT2 inhibitors reduce the risk of serious hyperkalemia and could therefore facilitate continued treatment with RAAS inhibitors and MRAs. Novel potassium binders, including sodium zirconium cyclosilicate and patiromer, effectively reduce blood potassium levels and prevent recurrent hyperkalaemia, thereby enabling sustained or intensified RAAS inhibitor therapy in patients with CKD and heart failure. Sodium zirconium cyclosilicate has also been shown to control predialysis hyperkalaemia in patients receiving haemodialysis. Emerging evidence suggests that potassium binders may have additional effects, including reductions in aldosterone levels, systolic blood pressure and urinary albumin excretion with patiromer, and increased serum bicarbonate concentrations with sodium zirconium cyclosilicate. By mitigating the risk of hyperkalemia, potassium binders could also enable some patients with CKD to adopt healthier potassium-rich, plant-predominant dietary patterns.