Historically hyperkalemia has been treated with gastrointestinal resin sodium polystyrene sulfonate (SPS, Kayexalate), but there are concerns about its safety and efficacy. Two newer compounds have been released which can be used to reduce blood potassium in hyperkalemia.

New agents:

(1) patiromer (patiromer calcium sorbitex, Veltassa), a potassium-absorbing resin

(2) sodium zirconium cyclosilicate (ZS-9, Lokelma), a nonabsorbable, inorganic crystal which selectively binds potassium and ammonium



(1) slower onset of reduce potassium, suited for chronic management

(2) gastrointestinal complaints (constipation, diarrhea)

(3) risk of hypomagnesemia


Sodium zirconium cyclosilicate:

(1) more rapid onset of reduced potassium, suited for acute management

(2) low rate of adverse effects (dose-dependent edema, gastrointestinal complaints)


Advantages over sodium polystyrene sulfonate:

(1) fewer side effects

(2) greater reduction in potassium

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