Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients

Abstract

IntroductionPatiromer is a potassium (K+) binding polymer indicated for treating hyperkalemia. Among patients receiving chronic hemodialysis (HD), this study aimed to identify patient characteristics associated with patiromer initiation, describe patiromer utilization, and analyze serum K+ pre- and post-patiromer initiation.MethodsIn a retrospective cohort study, using electronic health record data from a large dialysis provider in the United States (study period: December 21, 2015, to December 20, 2016), HD patients were included who had a medication order for patiromer, sodium polystyrene sulfonate (SPS), or laboratory evidence of hyperkalemia (no K+ binder [NoKb] cohort). The index date was the first order for patiromer/SPS, or the first K+ ≥5.0 mEq/l (NoKb cohort), respectively. Using multivariable logistic regression, we identified patient characteristics associated with patiromer initiation. We evaluated patiromer utilization using Kaplan-Meier methodology and proportion of days covered. Serum K+ concentrations were assessed pre- versus post-patiromer initiation.ResultsStudy cohorts included 527 (patiromer), 852 (SPS), and 8747 (NoKb) HD patients. Median follow-up was 141 days. Patiromer initiators were 2.6 times more likely to have had multiple prior episodes of hyperkalemia (odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.8–3.7). Most (61%) commenced patiromer on 8.4 g once daily; 60% of patients’ first patiromer order remained open after 180 days. Statistically significant reductions in K+, averaging approximately −0.5 mEq/l, were observed post-patiromer initiation (48% pre-patiromer vs. 22% post-patiromer had K+ ≥6.0 mEq/l [P < 0.001]).ConclusionPatiromer initiators receiving chronic hemodialysis had comparatively more severe, uncontrolled baseline hyperkalemia. Medication order data show long-term patiromer use was associated with significantly reduced K+.

Real-world management of hyperkalemia with patiromer among United States Veterans

“…This compares to 0% of patients with a K + concentration <5.1 mmol/L and 19% with <5.5 mmol/L before initiating patiromer (Figure 3). A similar percentage of patients achieving normokalemia (K + <5.1 mmol/L) was reported in two prospective, randomized trials (AMETHYST-DN [77%-95%] and OPAL-HK [76%]) [23,24].…”

“…This is the first study to provide an early report about patiromer utilization among US Veterans with HK. Recently, a real-world analysis of patiromer for the treatment of hyperkalemia in chronic hemodialysis patients was published [23]. However, to our knowledge, no other published studies have evaluated HK management with patiromer in a real-world setting of primarily CKD patients.…”

Potassium Binders for Hyperkalemia in Chronic Kidney Disease—Diet, Renin-Angiotensin-Aldosterone System Inhibitor Therapy, and Hemodialysis

“…105 A recent retrospective analysis of 527 patients undergoing hemodialysis who received patiromer for hyperkalemia found that treatment with patiromer was associated with a mean reduction in serum K þ of 0.5 mEq/L. 106 In this study, the proportion of patients with severe hyperkalemia (serum K þ !6.0 mEq/L) decreased from 64% at baseline to 23% after initiation of patiromer. 106 However, long-term real-world experience is needed to confirm the safety of patiromer and SZC if used as maintenance therapy.…”

“…106 In this study, the proportion of patients with severe hyperkalemia (serum K þ !6.0 mEq/L) decreased from 64% at baseline to 23% after initiation of patiromer. 106 However, long-term real-world experience is needed to confirm the safety of patiromer and SZC if used as maintenance therapy. 76,89 CONCLUSION Sodium zirconium cyclosilicate and patiromer have been found to be effective and tolerable in clinical trials and are viable alternatives to SPS for the management of hyperkalemia in patients with CKD.…”

Current Management of Hyperkalemia in Patients on Dialysis

“…1 Patients undergoing maintenance HD have a high risk of hyperkalemia, generally defined as serum potassium (K þ ) concentrations of >5.0 mmol/l, even when receiving adequate treatment with 3-times-weekly HD (Figure 1). 2,3 Hyperkalemia is a potentially lifethreatening disorder that can cause arrhythmias and sudden cardiac arrest. 3,4 In a US cohort study of patients undergoing HD between 2007 and 2010, the rate of hyperkalemia (K þ $5.5 mmol/l) was 16.3 to 16.8 per 100 patient-months.…”