PMID- 37517546
OWN - NLM
STAT- MEDLINE
DCOM- 20231124
LR  - 20231213
IS  - 1523-6838 (Electronic)
IS  - 0272-6386 (Linking)
VI  - 82
IP  - 6
DP  - 2023 Dec
TI  - Novel Therapies in Diabetic Kidney Disease and Risk of Hyperkalemia: A Review of 
      the Evidence From Clinical Trials.
PG  - 737-742
LID - S0272-6386(23)00743-6 [pii]
LID - 10.1053/j.ajkd.2023.04.015 [doi]
AB  - Concerns about hyperkalemia may result in the underuse of established and novel 
      therapies that improve kidney and/or cardiovascular (CV) outcomes in patients 
      with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). 
      Hyperkalemia-related issues are of particular relevance in patients with CKD, who 
      are commonly receiving other hyperkalemia-inducing agents such as 
      renin-angiotensin-aldosterone system inhibitors and nonsteroidal 
      mineralocorticoid receptor antagonists. In contrast, sodium/glucose transporter 2 
      (SGLT2) inhibitors mitigate the risk of serious hyperkalemia in clinical trials. 
      We aim to review recent evidence surrounding the risk of hyperkalemia in patients 
      with T2DM and CKD treated with established and novel therapies for diabetic 
      kidney disease, focusing on SGLT2 inhibitors and nonsteroidal mineralocorticoid 
      receptor antagonists. We conclude that SGLT2 inhibitors can be used safely in 
      patients with T2DM at high CV risk with CKD without increasing the risk of 
      hyperkalemia. Routine potassium monitoring is generally required when finerenone 
      is used as a kidney- and CV-protective agent in patients with T2DM. Based on 
      existing data, when added to the standard of care, combining SGLT2 inhibitors 
      with finerenone is safe and has the potential to exert additional cardiorenal 
      benefits in patients with diabetic kidney disease. The use of potassium binders 
      should be considered to enable optimal doses of guideline-based therapies for 
      patients with diabetic kidney disease to maximize the kidney and CV benefits.
CI  - Copyright (c) 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All 
      rights reserved.
FAU - Albakr, Rehab B
AU  - Albakr RB
AD  - Department of Medicine, Division of Nephrology, College of Medicine, King Saud 
      University, Riyadh, Saudi Arabia; Division of Nephrology, University of Toronto, 
      Toronto, ON, Canada; Division of Nephrology, Toronto General Hospital, University 
      Health Network, Toronto, ON, Canada.
FAU - Sridhar, Vikas S
AU  - Sridhar VS
AD  - Division of Nephrology, University of Toronto, Toronto, ON, Canada; Division of 
      Nephrology, Toronto General Hospital, University Health Network, Toronto, ON, 
      Canada.
FAU - Cherney, David Z I
AU  - Cherney DZI
AD  - Division of Nephrology, University of Toronto, Toronto, ON, Canada; Division of 
      Nephrology, Toronto General Hospital, University Health Network, Toronto, ON, 
      Canada. Electronic address: david.cherney@uhn.ca.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20230729
PL  - United States
TA  - Am J Kidney Dis
JT  - American journal of kidney diseases : the official journal of the National Kidney 
      Foundation
JID - 8110075
RN  - 0 (Mineralocorticoid Receptor Antagonists)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - RWP5GA015D (Potassium)
SB  - IM
MH  - Humans
MH  - *Hyperkalemia/etiology/drug therapy
MH  - Mineralocorticoid Receptor Antagonists/therapeutic use/pharmacology
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy
MH  - *Diabetic Nephropathies/drug therapy
MH  - *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
MH  - *Renal Insufficiency, Chronic/complications/drug therapy/chemically induced
MH  - Potassium
OTO - NOTNLM
OT  - Chronic kidney disease
OT  - SGLT2 inhibitors
OT  - diabetes
OT  - diabetic kidney disease
OT  - finerenone
OT  - hyperkalemia
OT  - nonsteroidal mineralocorticoid antagonist
OT  - potassium-binding therapies
EDAT- 2023/07/31 00:41
MHDA- 2023/11/24 06:43
CRDT- 2023/07/30 19:15
PHST- 2022/11/18 00:00 [received]
PHST- 2023/04/12 00:00 [revised]
PHST- 2023/04/22 00:00 [accepted]
PHST- 2023/11/24 06:43 [medline]
PHST- 2023/07/31 00:41 [pubmed]
PHST- 2023/07/30 19:15 [entrez]
AID - S0272-6386(23)00743-6 [pii]
AID - 10.1053/j.ajkd.2023.04.015 [doi]
PST - ppublish
SO  - Am J Kidney Dis. 2023 Dec;82(6):737-742. doi: 10.1053/j.ajkd.2023.04.015. Epub 
      2023 Jul 29.