The advent of new
potassium binders provides an important breakthrough in the chronic management of
hyperkalemia for people with CKD. In addition to the direct benefits of managing
hyperkalemia, many researchers and clinicians view these new medications as a possible means to safely transition patients away from the low-
potassium diet to a more healthful eating pattern. In this review, we examine the mechanisms of
potassium binders in the context of
hyperkalemia risk related to
dietary potassium intake in people with CKD. We note that whereas these medications target
hyperkalemia caused by
potassium bioaccumulation, the primary evidence for restricting
dietary potassium is risk of postprandial
hyperkalemia. The majority of ingested
potassium is absorbed alongside endogenously secreted
potassium in the small intestines, but the action of these novel medications is predominantly constrained to the large intestine. As a result and despite their effectiveness in lowering basal
potassium levels, it remains unclear whether
potassium binders would provide protection against
hyperkalemia caused by excessive
dietary potassium intake in people with CKD. Until this knowledge gap is bridged, clinicians should consider postprandial
hyperkalemia risk when removing restrictions on
dietary potassium intake in people with CKD on
potassium binders.