Would you start patiromer in a patient with CKD who has persistent hyperkalemia despite taking sodium zirconium cyclosilicate and adherence to a low potassium diet?

If the question is in addition to, I would first ensure adherence with SZC and diet (maybe measure 24-hour urine K) and maximize dose. Then, you might consider switching to patiromer rather than adding.

I have always thought of Lokelma and Veltassa to be of similar strengths. So the short answer is no. I would reduce the dose of medications that may cause a rise in serum potassium levels and/or increase the frequency of the potassium binder first.