Table 6.

Randomized controlled trials evaluating the efficacy and safety of newer potassium-binding resins in hyperkalemic patients already treated with RAAS-blockers

Patient characteristics	n	Year	Design	Intervention	Follow-up	Effect on SK	Major adverse events	Ref
			Studies with Patiromer
Outpatients with HF and a history of hyperkalemia or CKD receiving standard therapy and add-on spironolactone	105	2011	Double-blind RCT	Patiromer (30g/day) vs placebo	4 wks	↓	GI disorders (flatulence, diarrhea, constipation and vomiting) were morefrequent in the patiromer than in the placebo group (21% vs 6%, respectively)	46
Hyperkalemic outpatients with CKD already treated with RAAS-blockers	107	2014	Randomized, placebo-controlled withdrawal	Patiromer (4.2gr or 8.4gr twice a day) vs placebo	8 wks	↓	Constipation was the most frequently reported adverse event (incidence rate: 11%)	47
Hyperkalemic outpatients with CKD already treated with RAAS-blockers	306	2015	Open-Label, dose-ranging RCT	Patiromer (mild hyperkalemia stratum: 4.2, 8.4 or 12.6 gr twice daily; moderate hyperkalemia stratum: 8.4 or 12.6 gr twice daily) versus placebo	52 wks	↓	Hypomagnesemia, constipation and diarrhea had an overall incidence of 8.6%, 6.3% and 5.6%, respectively	48
			Studies with ZS-9
Hyperkalemic outpatients with HF, CKD or diabetes	237	2014	Double-blind RCT	ZS-9 (5, 10 or 15 gr daily) vs placebo	4 wks	↓	Dose-dependent increase in the incidence of edema	49
Hyperkalemic outpatients with HF, CKD or diabetes	753	2015	Double-blind RCT	ZS-9 (1.25, 2.5, 5, or 10 gr daily) vs placebo	2 wks	↓	GI disorders, mainly diarrhea, were the most commonly reported drug-related complications	50

Abbreviations: CKD= chronic kidney disease; GI= gastro-intestinal; HF= heart failure; RAAS= renin-angiotensin-aldosterone-system; RCT= randomized controlled trial; SK= serum potassium; ZS-9= sodium zirconium cyclosilicate;