{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:58:54Z","timestamp":1785473934069,"version":"3.56.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,4,22]],"date-time":"2023-04-22T00:00:00Z","timestamp":1682121600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,31]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>\u2018Old-generation\u2019 potassium (K) binders [i.e. sodium (SPS) and calcium polystyrene sulfonate] are widely used, but with substantial heterogeneity across countries to treat hyperkalaemia (HK). However, there are no randomized data to support their chronic use to manage HK, nor have they been shown to have a renin\u2013angiotensin\u2013aldosterone system inhibitor (RAASi)-enabling effect. These compounds have poor tolerability and an unpredictable onset of action and magnitude of K lowering. Furthermore, SPS may induce fluid overload, owing to the fact that it exchanges K for sodium. Its use has also been associated with colonic necrosis, as emphasized by a black box warning from the US Food and Drug Administration. In contrast, two new K binders, patiromer and sodium zirconium cyclosilicate, have been shown to be safe and well tolerated for chronic management of HK, thereby enabling RAASi optimization, as acknowledged by the latest international cardiorenal guidelines. In view of the lack of reliable evidence regarding the efficacy and safety of the old-generation K binders compared with the placebo-controlled randomized and real-word evidence demonstrating the safety, efficacy and RAASi-enabling effect of the new K binders, clinicians should now use these new K binders to treat HK (primum non nocere!).<\/jats:p>","DOI":"10.1093\/ckj\/sfad090","type":"journal-article","created":{"date-parts":[[2023,4,22]],"date-time":"2023-04-22T09:58:15Z","timestamp":1682157495000},"page":"1221-1225","source":"Crossref","is-referenced-by-count":14,"title":["Sodium polystyrene is unsafe and should not be prescribed for the treatment of hyperkalaemia: <i>primum non nocere<\/i>!"],"prefix":"10.1093","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4470-7932","authenticated-orcid":false,"given":"Patrick","family":"Rossignol","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques-Plurith\u00e9matique 14-33, Inserm U1116, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy , France"},{"name":"Medicine and Nephrology-Dialysis Departments, Princess Grace Hospital, and Monaco Private Hemodialysis Centre , Monaco , Monaco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"University of Michigan School of Medicine , Ann Arbor, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"key":"2023073100365257300_bib1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1159\/000360094","article-title":"Potassium-binding resins: associations with serum chemistries and interdialytic weight gain in hemodialysis patients","volume":"39","author":"Jadoul","year":"2014","journal-title":"Am J Nephrol"},{"key":"2023073100365257300_bib2","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1093\/ckj\/sfz129","article-title":"Recurrent hyperkalaemia management and use of renin-angiotensin-aldosterone system inhibitors: a European multi-national targeted chart review","volume":"13","author":"Rossignol","year":"2020","journal-title":"Clin Kidney J"},{"key":"2023073100365257300_bib3","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1093\/ndt\/gfx053","article-title":"Hyperkalaemia prevalence, recurrence and management in chronic haemodialysis: a prospective multicentre French regional registry 2-year survey","volume":"32","author":"Rossignol","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"2023073100365257300_bib4","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1007\/s40265-021-01555-5","article-title":"Hyperkalemia in chronic kidney disease in the new era of kidney protection therapies","volume":"81","author":"Valdivielso","year":"2021","journal-title":"Drugs"},{"key":"2023073100365257300_bib5","doi-asserted-by":"crossref","first-page":"2836","DOI":"10.1016\/j.jacc.2020.04.021","article-title":"Abnormalities of potassium in heart failure: JACC state-of-the-art review","volume":"75","author":"Ferreira","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2023073100365257300_bib6","article-title":"Kayexalate\u00ae Sodium Polystyrene Sulfonate, USP. 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