Patiromer monotherapy reduces potassium levels without hypokalemia risk in hyperkalemia: JAMA

Bronx, New York: A team of researchers led by Katherine E. Di Palo conducted a study that showed that a single dosage of patiromer was linked with a considerable drop in blood potassium levels and a low risk of hypokalemia in individuals with acute, non–life-threatening hyperkalemia. The findings of this study were published in the Journal of American Medical Association.

Hyperkalemia is a prevalent electrolyte problem in hospitalized patients; however, the therapeutic utility of giving patiromer for serum potassium level lowering in this situation is uncertain. The objective of this study was to assess the efficacy of patiromer as monotherapy in patients with acute hyperkalemia in an acute care scenario.

Between January 30, 2018, and December 30, 2019, this cohort research examined electronic health record data from adult patients treated with patiromer for acute hyperkalemia in emergency departments, inpatient units, and critical care units at an urban, academic medical facility in the Bronx, New York. The data was analyzed between June 2020 and February 2021. Participants were given a single dosage of patiromer orally (8.4 g, 16.8 g, or 25.2 g). The primary outcome was the mean absolute drop in blood potassium level from baseline after patiromer injection at three independent time intervals: 0 to 6 hours, greater than 6 to 12 hours, and greater than 12 to 24 hours. The incidence of hypokalemia and potassium reduction stratified by baseline potassium level and care context were important secondary outcomes.

The key findings of this study were as follow:

1. The mean (SD) age of patients receiving patiromer therapy among 881 encounters was 67.4 (14.4) years; 463 encounters (52.6%) were for male patients, and the majority (338 [38.4%]) were for patients who identified as non-Hispanic Black.

2. The mean (SD) baseline serum potassium level was 5.60 (0.35) mEq/L, and the mean (SD) potassium decrease during the first 6 hours following patiromer delivery was 0.50 (0.56) mEq/L.

3. The absolute and relative potassium decrease from baseline differed depending on the severity of the baseline hyperkalemia, but not by care setting.

4. In 721 interactions (81.8%), the lowest dose of patiromer (8.4 g) was utilized, and no further doses of a potassium binder were necessary in 725 encounters (82.3%).

5. At 24 hours following patiromer treatment, hypokalemia was seen in two cases (0.2%).

In conclusion, the findings imply that bouts of non–life-threatening hyperkalemia may be managed in an acute care context with patiromer monotherapy to help reduce the risk of hypokalemia associated with other potassium management strategies.

Reference:

Di Palo KE, Sinnett MJ, Goriacko P. Assessment of Patiromer Monotherapy for Hyperkalemia in an Acute Care Setting. JAMA Netw Open. 2022;5(1):e2145236. doi:10.1001/jamanetworkopen.2021.45236