Focus on Hyperkalemia Management: Expert Consensus and Economic Impacts

Alvarez, Paula J; Brenner, Melanie; Butler, J. H.; Farnum, Carolyn; Kangethe, Anne; Lafayette, Richard A.; Lopes, Maria Carolina Barbosa Teixeira; Lord, Todd; Oestreicher, Nina; Onuigbo, Macaulay; Peacock, W. Frank; Pitt, Bertram; Polson, Michael; Rafique, Zubaid; Speicher, Lindsay C; Weir, Matthew R.

doi:10.18553/jmcp.2017.23.4-a.s2

Cited by 4 publications

(1 citation statement)

References 23 publications

(52 reference statements)

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“…This issue is increasingly evident with the greater use of renin-angiotensin-aldosterone system (RAAS) inhibitors, which have been shown to improve survival in patients with HF [3,4,5] and decrease proteinuria and the slow progression of CKD [6,7,8]. Moreover, optimal RAAS inhibitor dosing has been associated with enhanced survival and lower medical costs compared with suboptimal dosing in observational studies [9,10,11]. Despite their life-prolonging and disease-modifying effects, RAAS inhibitor use is often limited to less than maximal doses or discontinued due to the development of hyperkalemia [12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

Patiromer Lowers Serum Potassium When Taken without Food: Comparison to Dosing with Food from an Open-Label, Randomized, Parallel Group Hyperkalemia Study

et al. 2017

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Background: Patiromer is a sodium-free, nonabsorbed, potassium binder approved for treatment of hyperkalemia. This open-label study compares the efficacy and safety of patiromer administered without food versus with food. Methods: Adults with hyperkalemia (potassium ≥5.0 mEq/L) were randomized (1:1) to receive patiromer once daily without food or with food for 4 weeks. The dosage was adjusted (maximum: 25.2 g/day) using a prespecified titration schedule to achieve and maintain potassium within a target range (3.8-5.0 mEq/L). The primary efficacy endpoint was the proportion of patients with serum potassium in the target range at either week 3 or week 4. Safety was assessed by adverse events (AEs) and laboratory testing. Results: Efficacy was evaluated in 112 patients; 65.2% were ≥65 years of age, 75.9% had chronic kidney disease, and 82.1% had diabetes. Baseline mean serum potassium was similar in the without-food (5.44 mEq/L) and with-food (5.34 mEq/L) groups. The primary endpoint was achieved by 87.3% (95% CI 75.5-94.7) and 82.5% (95% CI 70.1-91.3) of patients in the with-food and without-food groups, respectively; least squares mean changes in serum potassium from baseline to week 4 were -0.65 and -0.62 mEq/L, respectively (p < 0.0001). The most common AEs were diarrhea and constipation. Serum K⁺ remained ≥3.5 mEq/L in all patients; 5 patients developed serum magnesium <1.4 mg/dL, including 4 whose baseline magnesium was below the lower limit of normal. Conclusion: Patiromer is equally effective and well tolerated when taken without food or with food, thereby offering the potential for dosing flexibility.

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