Hyperkalemia treatment modalities: A descriptive observational study focused on medication and healthcare resource utilization

Abstract

Renin-angiotensin-aldosterone system inhibitor (RAASi) therapy has been shown to improve outcomes among patients with congestive heart failure, diabetes, or renal dysfunction. These patients are also at risk for the development of hyperkalemia (HK), often leading to down-titration and/or discontinuation of RAASi therapy. Patiromer is the first sodium-free, non-absorbed potassium (K +) binder approved for the treatment of hyperkalemia (HK) in over 50 years. We described the association between use of K + binders (Patiromer and sodium polystyrene sulfonate [SPS]) and renin-angiotensin-aldosterone system inhibitor (RAASi), on healthcare resource utilization (HRU). The study population consisted of Medicare Advantage patients with HK (K + � 5.0 mmol/L) in Optum's Clinformatics ® Data Mart between 1/1/2016-12/31/2017. Patiromer and (SPS) initiators, and HK patients not exposed to a K + binder (NoKb) were included. The index date was the date of the first K + binder dispensing or HK diagnosis. Outcomes assessed at 6 months post-index were: (1) K + binder utilization, (2) RAASi continuation, and (3) HRU (pre-vs post-index). HRU change was analyzed using McNemar's statistical test. Study cohorts included 610 (patiromer), 5556 (SPS), and 21,282 (NoKb) patients. Overall baseline patient characteristics were: mean age 75 years; female 49%, low-income subsidy 29%, chronic kidney disease 48% (63% for patiromer cohort), and congestive heart failure 29%. At 6 months post-index, 28% (patiromer) and 2% (SPS) remained continuously exposed to the index K + binder. RAASi continued for 78% (patiromer), 57% (SPS), and 57% (NoKb). The difference (pre-vs postindex) in hospitalized patients was:-9.4% (patiromer; P<0.05),-7.2% (SPS), and +16.8% (NoKb; P<0.001). Disparate K + binder utilization patterns were observed. The majority of patiromer patients continued RAASi therapy while the percentage of SPS patients that continued RAASi therapy was lower, overlapping CIs were observed. Following continuous

Safety and Tolerability of the Potassium Binder Patiromer From a Global Pharmacovigilance Database Collected Over 4 Years Compared with Data from the Clinical Trial Program

“…These data were derived from four clinical trials [ 10 , 11 , 15 , 16 ] in which patients were initiated on patiromer in divided doses between 8.4 and 33.6 g daily. Real-world data indicate that the most widely used patiromer starting dose in clinical practice is 8.4 g daily [ 17 , 18 ].…”

Healthcare utilization and expenditures associated with hyperkalemia management: a retrospective study of Medicare Advantage patients

“…22 [21] days). For patients with a exposed HK episode, the first patiromer-exposed HK episode was included and analyzed.…”

“…While there are several published observational studies comparing HRU and healthcare expenditures for patients with and without HK 2,[12][13][14][15] , research regarding the relative effect of different treatment modalities among patients with HK are emerging 14,[19][20][21][22][23][24][25] . Among Medicare Advantage patients with HK in real-world clinical practice, this study aimed to evaluate the outcomes for patients exposed to patiromer compared to patients not exposed to a K + binder.…”

Hyperkalemia in heart failure: current treatment and new therapeutic perspectives

“…According to their characteristics, ZS-9 could be a useful drug in the acute hyperkalemia setting, while patiromer could be used in the chronic context. Such drugs could therefore represent an additional weapon for cardiologists in the management of patients with HF in order to avoid underdosing or withdrawal of essential drugs, with potential consequent benefit in terms of prognosis (Desai et al, 2020;Kovesdy et al, 2020;Sciatti et al, 2019).…”