Using a real-world patient case, Drs. Ellie Kelepouris and Nihar Desai examine clinical challenges in managing hyperkalemia among patients with chronic kidney disease (CKD) and heart failure (HF). They explore the use of modern potassium binders to sustain guideline-directed medical therapy (GDMT) with renin–angiotensin–aldosterone system (RAAS) inhibitors and break down the differences between patiromer and sodium zirconium cyclosilicate (SZC). Their discussion includes guideline recommendations from KDIGO and European societies, the sodium-related safety signals with SZC, and supporting data from trials such as REALIZE-K and DIAMOND. Findings from the CARE-HK registry are also discussed, highlighting low potassium binder use despite high rates of recurrent hyperkalemia and underutilization of GDMT in advanced CKD.