A sweet alternative to kayexelate?

Trust the Swiss to approach a problem from a confectioners viewpoint. The options for managing hyperkalemia in dialysis patients have always been limited and unpalatable, but this preliminary clinical study from Berne provides some hope. It suggests that giving glycyrrhetinic acid may be effective. This compound, commonly found in liquorice, usually just makes up the numbers somewhere near the bottom of lists of causes of secondary hyperaldsteronism. It works by inhibiting the enzyme 11b-hydroxy-steroid dehydrogenase II, increasing cortisol availability at the mineralocorticoid receptor. It appears that there is significant expression of this receptor in the colon, potentially explaining the potassium-lowering effect in ESRD.

Over 6 months of follow-up, the frequency of severe hyperkalemia significantly decreased from 9% to 0.6% in the treatment arm of this small, prospective RCT. Mean pre- and post dialysis systolic/diastolic blood pressure values were comparable on GA and placebo. However, before you start reaching for the Allsorts, be aware that this was a tiny study (10 patients) and needs a longer term study of toxicity before widespread use can be proposed.