{"id":"6e50d85f984f","type":"article","url":"https://hartvaat.nl/2026/08/14/kaliumbinders-ondersteunen-raasi-gebruik-bij-ckd-maar-terugkeer-van-hyperkaliemi/","title":"Kaliumbinders ondersteunen RAASi-gebruik bij CKD, maar terugkeer van hyperkaliëmie versnelt nierfunctieverlies","title_en":"Optimizing hyperkalemia management in CKD: real-world nephrologist strategies and impact on patient outcomes.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Journal of nephrology","doi":"10.1093/joneph/aajag149","source_url":"https://doi.org/10.1093/joneph/aajag149","authors":["María Marques","Paula López-Sánchez","Enrique Morales","M Auxiliadora Bajo","Antolina Rodriguez","Milagros Fernández Lucas","Vicente Paraiso","Laura Bucalo","Yolanda Hernandez","José C De La Flor","Maite Padrón","Hanane Bouarich","Fabio Procaccini","Coraima Nava Chavez","Jose Herrero","Fernando Tornero"],"significance":5,"published":"2026-08-22","source_date":"2026-08-14","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"A prospective multicenter observational study (n=429) evaluated real-world management of hyperkalemia in patients with chronic kidney disease (CKD). Hyperkalemia recurred in 43.8% of patients over two years, a pattern associated with a significantly faster eGFR decline of 2.4 ml/min/year. While potassium binders (patiromer and sodium zirconium cyclosilicate) facilitate the continuation of RAAS inhibitors and MRAs, recurrent episodes remain common and may accelerate renal deterioration. Clinicians should consider early integration of potassium binders to sustain guideline-directed cardiorenal therapies and mitigate kidney function loss.","created":"2026-08-15T01:17:28Z","updated":"2026-08-15T01:17:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een prospectieve multicenterobservatiestudie (n=429) onderzocht het reële klinische beleid bij hyperkaliëmie bij patiënten met chronische nierziekte (CKD). Na een hyperkaliëmie-episode kwam 43,8% van de patiënten terug met een verhoogd kalium, wat geassocieerd werd met een versnelde eGFR-daling van 2,4 ml/min/jaar. Hoewel kaliumbinders zoals patiromer en SZC helpen om RAAS-remmers en mineralocorticoïd-receptorantagonisten te behouden, blijft het terugkeren van hyperkaliëmie een groot probleem dat de nierfunctie aantast. Klinisch belang: continue monitoring en vroegtijdige inzet van kaliumbinders zijn nodig om cardiorenale therapieën vol te houden en nierdaling te vertragen.","abstract_original":"BACKGROUND: Hyperkalemia is a common complication in chronic kidney disease (CKD), requiring management to maintain cardiovascular benefits of renin-angiotensin-aldosterone system and mineralocorticoid receptors (RAASi/MRA) therapy. This study evaluated hyperkalemia management and recurrence in CKD patients. METHODS: A prospective, multicenter observational study was conducted across 15 hospitals, enrolling 429 patients with serum potassium > 5.5 mmol/L. Patients were managed per usual practice, and data on recurrence, RAASi/MRA changes, cardiovascular events, and renal function were collected over 2 years. RESULTS: Cohort (mean age 71.5 years, 71.3% male, 88.6% hypertension, 55.9% diabetes) presented with mild, moderate (19.1%), and severe (3.7%) hyperkalemia. Post-event, dietary modifications increased by 39.9%, bicarbonate use by 7.9%, resin use by 2.6%, patiromer use by 10.9%, and sodium zirconium cyclosilicate (SZC) use by 24.6%. Modifications on RAA Si/MRA therapy were as follows: angiotensin-converting enzyme inhibitors reduced in 12% and suspended in 6.8%; angiotensin II receptor blockers reduced in 5.49% and suspended in 7.32%; and MRA reduced in 12.73% and suspended in 21.82%. Recurrence occurred in 43.8%, with higher rates in patients with baseline estimated glomerular filtration rate <30 ml/min (49.1% vs 38.8%, P = 0.03). Recurrent hyperkalemia was associated with faster eGFR decline (-2.4 ml/min/year, P < 0.001). Kaplan-Meier analysis showed no differences in overall survival between patients with and without recurrence. The study found no significant difference between patiromer/SZC and resins in efficacy (recurrence rates). CONCLUSION: Integrating potassium binders into CKD therapeutic strategies may improve hyperkalemia management and allow sustained RAASi/MRA use. Recurrence remains significant, impacting renal function, although causality is unclear. The mortality difference requires further study."}