New potassium binders: we need them - we do not need them

Abstract New potassium binders may facilitate contemporary chronic kidney disease care by controlling hyperkalemia and thereby facilitating the continued use of kidney- and cardioprotective therapies, particularly renin-angiotensin-aldosterone system inhibitors. The opposing view is that sodium polystyrene sulfonate remains effective, familiar, inexpensive, and often well tolerated, while direct comparative evidence has not yet shown clinically meaningful superiority of newer binders. This debate weighs clinical utility, comparative efficacy, safety, and cost, concluding that new binders are valuable options but that their routine replacement of established low-dose sodium polystyrene sulfonate and the need for potassium binders beyond optimized diuretic therapy, acidosis control, diet etc. requires stronger comparative evidence.