A sweet alternative to kayexelate?

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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.


  1. But in patients with CKD and very little renal function how much of an effect will be there on distal tubules for potassium excretion? VR

  2. Hmmmmm…a sweet alternative?? This, I'd like to know about.
    I wish there was something like kayexelate, only in pill form…and with a sweet aftertaste for good measure! And available by prescription…like phosphate binders.
    Believe me: I know how horrible that kayexelate tastes! I remember I had to take it once when I was in the hospital. I specifically requested a ton of sugar so I could mix the sugar in, so that it might not taste so bad…BLECH!!!

  3. I believe that Earl Grey tea also has a potassium lowering effect.

  4. Hi AK,
    Good point, I forgot to mention that. The mean pre- and post dialysis systolic/diastolic blood pressure
    values were comparable on GA and placebo. I've updated the piece.
    Thanks for the feedback,

  5. It will be intersting also to know their blood pressure control with this treatment as most of these patients have high BP and obviously this kind of treatment will affect BP.


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