Apart from dialysis, sodium/potassium exchange resins are the only reasonably effective means of removing excess potassium from the body in the setting of renal failure. I suppose the induction of a diarrhea can lead to GI potassium losses, but there is no way of controlling the losses or the other electrolytes that may also be lost.
Shifting potassium intracellularly may be effective in loweing serum potassium, but is only a temporary effect as the excess potassium will eventually shift back into the extracellular space. Whether 15 minutes, or several hours, I as a clinician will have to figure out a way to rid the excess potassium load.
It is interesting to observe nephrologists render negative opinions regarding the use of Kayexelate-sorbitol as the only other effective means of removing excessive potassium is dialysis. Dialysis itself is not a benign procedure and fraught with risks, especially for short term therapy, that might actually be worse than a single or even perhaps a few doses of Kayexelate.
Even more than a randomized DCT testing Kayexelate, I would like to see a head to head trial of Kayexelate versus dialysis in the short term management of hyperkalemia due to potassium excess, monitoring outcome events both in the short and long term.
Perhaps the majority of Kayexelate use can be avoided. Insulin and glucose can be administered regularly waiting for renal function to recover. Dialysis would be necessary in any case for those, whose renal recovery is delayed or fails to occur. However, in the short term, hyperkalemia is a very dangerous condition. Lowering the serum potassium is imperative. But, and this is a big but, there are no controlled trials assessing outcomes for any of the other potassium lowering modalities either.