Potassium Binders

Haemodialysis removes potassium effectively but is invasive and may not be immediately available in the emergency department. The ENERGIZE trial of sodium zirconium cyclosilicate in the emergency department also found no difference in its primary efficacy endpoint and ended prematurely due to slow enrolment. Demonstrating potassium binder efficacy in the emergency department is difficult because stabilising treatments produce transient potassium shifts and emergency department turnover is rapid. The REDUCE pilot study showed a trend toward lower serum potassium and fewer potassium-lowering agents with patiromer but was underpowered for statistical significance. Sodium polystyrene sulfonate is FDA-approved as a potassium binder but is limited by gastrointestinal adverse effects including nausea, vomiting, and reports of colonic necrosis.