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Chronic Hyperkalaemia Management — RACP Adult Medicine MCQ

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HardNephrologyChronic Hyperkalaemia ManagementRACP Adult Medicine

A 60-year-old man with type 2 diabetes and CKD develops persistent hyperkalaemia (K+ 6.2 mmol/L) despite dietary modification and cessation of spironolactone. He needs to remain on ramipril for cardio-renal protection. What is the most appropriate additional agent?

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Correct answer: C — Patiromer (potassium binder)

Patiromer is a newer potassium binder approved for chronic hyperkalaemia management. It enables continued use of RAS inhibitors and MRAs by binding potassium in the GI tract. Unlike sodium polystyrene sulfonate (calcium resonium), patiromer has demonstrated efficacy and safety in clinical trials (OPAL-HK, AMETHYST-DN) without the risk of intestinal necrosis. Sodium zirconium cyclosilicate (Lokelma) is another newer option. Maintaining RAAS blockade is important for cardio-renal protection.

Reference: AMH – 2025 – Potassium-Lowering Agents; KDIGO – 2024 – CKD Guidelines