Photo Credit: Ekaterina Chizhevskaya

The following is a summary of “Potassium binders in clinical practice: understanding potassium binder use in contemporary Swedish healthcare—the DEMONSTRATE database,” published in the April 2025 issue of BMC Nephrology by Furuland et al. 

Potassium binders help manage hyperkalemia, enabling continued renin-angiotensin-aldosterone-system inhibitor (RAASi) therapy. Their effectiveness in balancing potassium levels supports optimal treatment outcomes, particularly in patients with comorbid conditions such as hypertension, which commonly coexists with hyperkalemia and contributes to cardiovascular risk. 

Researchers conducted a retrospective study on patients using first- or second-generation potassium binders, focusing on usage patterns, potassium level reduction, and RAASi treatment changes. 

They included patients from a National Cohort who received first- or second-generation potassium binders between 2018 and 2022. A Mid-Sweden Cohort was formed with patients from the National Cohort who had a potassium measurement within 60 days before starting treatment. Comorbidities, including hypertension, prior medication use, persistence with treatment, changes in potassium levels, and RAASi treatment were evaluated. Persistence was analyzed using the Kaplan-Meier estimator, and changes in potassium levels were assessed using linear mixed-effects models. 

The results showed 23,892 treatment episodes involving 14,235 patients (mean age 70 years, 33% women) in the National Cohort and 4,860 episodes involving 3,179 patients (mean age 72 years, 34% women) in the Mid-Sweden Cohort. Second-generation potassium binders had more comorbidities—particularly hypertension—and higher median persistence with treatment compared to first-generation binders: 112.5 (95% CI: 112.5–117.5) vs. 87.5 (95% CI: 87.5–87.5) days in the National Cohort; 165.5 (95% CI: 121.0–198.0) vs. 97.6 (95% CI: 87.5–110.0) days in the Mid-Sweden Cohort. Both binder types reduced potassium levels from baseline by day 15: 5.7 (95% CI: 4.5–6.8) mmol/L to 4.7 (95% CI: 3.6–5.9) mmol/L for first-generation and 5.5 (95% CI: 4.3–6.7) mmol/L to 4.9 (95% CI: 3.8–6.1) mmol/L for second-generation. Dose reduction or discontinuation of RAASi or MRAs occurred in 31.4% and 47.7%, respectively, within 120 days. 

Investigators found that both potassium binders effectively reduced potassium levels, but frequent discontinuation or dose reduction of RAASi therapy occurred. In patients with hypertension, this raises concern, as RAASi therapy plays a central role in blood pressure and cardiovascular risk management. Adjustments to RAASi therapy, despite achieving normokalemia within 15 days, may have been premature and required careful reconsideration. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-04146-8