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1/ Understanding the pathophysiology of hyperkalemia in CKD 2-4 - This article - emedicine.medscape.com/article/242494… has a good explanation. "In true hyporeninemic hypoaldosteronism, atrophy of the juxtaglomerular apparatus may be present; this may be more prevalent in diabetics."
2/ Many diabetic patients have incomplete loss of renin. Thus they are more prone to hyperkalemia after starting an ACE, ARB or aldo blocker. This often leads to the conundrum of a strong indication (proteinuria) and strong contraindication for ACE/ARB.
3/ These patients as well as diabetic CKD patients with systolic dysfunction (who also have a strong indication for ACE/ARB/aldo blocker) can face the same problem.
4/ This explains the investment in developing the new potassium resins - patiromer (Valtessa) and Sodium Zirconium Cyclosilicilate (Lokelma). But very costly - goodrx.com/veltassa and goodrx.com/lokelma
If money were no object ... but money always does matter.
If money were no object ... but money always does matter.
