This condition often limits up-titration or use of evidence-based doses of these therapies in HF and CKD.181 The concomitant use of an ARNI or SGLT2 inhibitor has been shown to lower risks of hyperkalemia related to both classes of MRA, and combination use may promote treatment persistence in practice.182 The use of potassium binders such as patiromer and sodium zirconium cyclosilicate may be considered to facilitate use of these therapies among patients who experience therapy-related hyperkalemia. The gene discussed is SLC5A2; the disease is hydrops fetalis.