Potassium: It’s a Bit of a Bind(er)

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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

Could controlling potassium be the key to giving more patients the heart- and kidney-protective treatment they need?

High potassium can prevent people with chronic kidney disease or heart failure from receiving optimal doses of ACE inhibitors, ARBs and other RAAS inhibitors. In this episode of For Kidneys Sake, Jeremy and Andrew examine updated NICE guidance that lowers the potassium threshold for starting sodium zirconium cyclosilicate, better known as Lokelma, from 6.0 to 5.5 mmol/L in eligible patients.

They explore what this change means for primary care, including who may benefit, what to check before prescribing and how to start, adjust and monitor potassium binders. Most importantly, they explain why lowering potassium is not the ultimate goal: it is about enabling patients to receive the medicines that protect their hearts, preserve kidney function and improve long-term outcomes.

Five key takeaways

1. The Lokelma threshold has changed. Eligible patients may now start treatment when their potassium is persistently at or above 5.5 mmol/L.
2. Potassium binders are enabling treatments. Their purpose is to make it possible to start, continue or increase heart- and kidney-protective RAAS inhibitors.
3. Primary care can initiate Lokelma. Treatment may be started following advice from secondary care, which does not always require a face-to-face appointment.
4. Check before prescribing. Confirm the potassium result, exclude pseudohyperkalaemia, review contributing medicines and provide appropriate dietary guidance.
5. Do not stop once potassium improves. After controlling potassium, review and optimise the patient’s ACE inhibitor, ARB or other appropriate RAAS inhibitor—that is where the main long-term benefit lies.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

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