The Role of Patiromer in Delaying the Onset of Renal Replacement Therapy in Patients with Advanced Renal Failure

Abstract

Patients with chronic kidney disease (CKD) are at an increased risk of developing hyperkalemia, which can be potentially life threatening. Hyperkalemia is frequently encountered with renin-angiotensin-aldosterone system inhibitor (RAASi) therapy use in patients with CKD and often results in the underdosing or discontinuation of these drugs. RAASi therapy has been proven to delay the progression of CKD, ameliorate proteinuria, and reduce the overall risk of cardiovascular morbidity and mortality. Patiromer is a sodium-free, potassium-binding polymer used for the treatment of hyperkalemia. We present a case series of four patients with Stage 4 or 5 CKD in whom the initiation of dialysis was delayed with the use of patiromer. For one patient, dialysis was delayed by 18 months, whereas the remaining three patients, in whom hyperkalemia was one of the main complications, remain dialysis independent to date.

Wearable and implantable artificial kidney devices for end‐stage kidney disease treatment: Current status and review

“…Oral potassium binders have been improved significantly with the market introduction of patiromer and sodium zirconium cyclosilicate (SZC). [42][43][44] Previously sodium polystyrene sulfonate (SPSS) was used to treat hyperkalemia but was not highly effective, it often was given with an osmotic laxative, which had occasional adverse effects on the gut. 45 The newer agents are more effective, better tolerated (even in long-term use) and have been shown to be able to help control serum potassium levels between dialysis therapies.…”

“…The medication is currently still in clinical trials. Oral potassium binders have been improved significantly with the market introduction of patiromer and sodium zirconium cyclosilicate (SZC) 42–44 . Previously sodium polystyrene sulfonate (SPSS) was used to treat hyperkalemia but was not highly effective, it often was given with an osmotic laxative, which had occasional adverse effects on the gut 45 .…”