In 2019, we welcomed several major advances made in the management of kidney disease. We have decided to highlight herein two major developments. Firstly, pregnancy can now be considered in a patient upon chronic dialysis. Secondly, two new potassium binders are on the horizon, which is great news for patients with chronic kidney disease requiring renin angiotensin system (RAS) blockade.
Pregnancy, which is in fact rare in women with end-stage kidney failure, is associated with increased feto-maternal morbidity. Recent data, along with our own experience, highlight that pregnancy can now be considered in women on maintenance hemodialysis, who are ready to perform intensive home hemodialysis, along with a strict and regular obstetrical follow-up.
Hyperkalemia is common in chronic kidney disease patients, especially in those under RAS blockade, and can be life-threatening. Since the old K-binders have limited efficacy and are poorly tolerated, RAS blockade is frequently discontinued in such patients. Nevertheless, two new K-binders are on the horizon. The first one, patiromer, has been reimbursed since 2019 for the treatment of chronic hyperkalemia. The other one, sodium cyclosilicate of zirconium (SZC), has been approved for use in Europe, though this drug is not yet reimbursed in Belgium. We briefly review these molecules’ efficacy and safety and discuss their role in maintaining RAS blockade, especially in CKD patients with proteinuria or heart failure.