High blood potassium is a common problem in kidney patients. Excessive blood potassium may cause heartbeat slowdown or even cardiac arrest, so high blood potassium must be taken seriously by kidney patients. The causes of hyperkalemia are related to food, fruits and some medications, and the timely treatment of hyperkalemia is also very important. This article introduces you to the progress of the treatment of hyperkalemia. The acute treatment of hyperkalemia focuses on promoting the transfer of extracellular potassium to the intracellular level, which can temporarily reduce the blood potassium concentration. Common treatments for severe hyperkalemia, such as intravenous calcium supplementation, insulin, sodium bicarbonate and inhaled beta-adrenergic agonists, do not clear excess blood potassium and are not usually feasible in outpatient treatment. methods to control blood potassium concentrations in outpatients with CKD include: limiting potassium intake, using ion exchange resins to promote urinary potassium excretion and promoting potassium excretion from the bowel. Limiting potassium intake The primary method of early intervention for non-severe chronic hyperkalemia is to limit potassium intake and avoid potassium-rich foods. Patients with persistent hyperkalemia also need to reduce the intake of uncommon potassium-containing foods, such as salt substitutes and herbs, and avoid high intake of low-potassium foods, such as strawberries or grapes. Promoting urinary potassium excretion If potassium intake restriction is not effective, potassium excretion can be promoted by stopping/reducing medications that affect potassium excretion or by giving potassium excretory drugs. Common drugs that can affect potassium excretion include RAAS inhibitors (e.g., ACEI, ARB) and salt corticosteroid receptor antagonists; other drugs include calcium-modulated neurophosphatase inhibitors, NSAIDs, heparin, ketoconazole, potassium-preserving diuretics, methotrexate, and pentazocine. Tab diuretics may also be given singly or in combination with thiazide diuretics to promote potassium excretion. Promoting potassium excretion from the gastrointestinal tract Promoting potassium excretion from the gastrointestinal tract is an effective way to remove potassium from the blood and allows the continued use of RAAS inhibitors. A commonly used drug to promote potassium excretion from the intestine is sodium polystyrene sulfonate (SPS), but its effectiveness is less than optimal and can lead to potential adverse effects. In the past, SPS was often used in combination with 70% sorbitol to prevent constipation and promote potassium excretion, but the combination of these two drugs could lead to serious, even fatal, gastrointestinal complications, so in 2009 the FDA announced that the combination of the two drugs should be avoided. Currently, SPS is often co-administered with low concentrations of sorbitol, but serious gastrointestinal adverse reactions can still occur (with a low incidence). Patiromer Patiromer is an ion exchange resin that was approved in November 2015. It binds potassium primarily in the colon and promotes excretion of potassium from the feces, significantly reducing blood potassium levels. The most common adverse reaction is constipation, which can lead to discontinuation in 6-9% of patients; other adverse reactions include mild hypomagnesemia, hypokalemia. the FDA requires that Patiromer be taken at least 6 hours apart when taken concurrently with other medications. Zirconium cyclic sodium silicate (ZS-9) ZS-9 is another novel hyperkalemia treatment that selectively binds potassium in the intestine and has completed a phase 3 study. It can significantly reduce blood potassium levels and has a relatively good safety profile. While both Patiromer and ZS-9 have had exciting study successes, they still have limitations. Patiromer has been approved by the FDA, but should be taken more than 6 hours apart when taken concurrently with other oral medications. ZS-9, on the other hand, has not yet been approved by the FDA. The effectiveness and safety of the two new therapeutic agents need to be further studied. In conclusion: The treatment of chronic hyperkalemia has remained largely unchanged since the 1950s. Restriction of potassium intake and promotion of urinary potassium excretion are the mainstay of outpatient treatment for mild to moderate hyperkalemia. The new therapeutic agent ion exchange resin can promote potassium excretion from the intestine and is expected to be an effective treatment agent for hyperkalemia in patients with CKD.