Approximately one-third of hospitalized patients with hyperkalemia receive potassium binders, with differential use of sodium polystyrene sulfonate (SPS), patiromer, and sodium zirconium cyclosilicate (SZC), investigators reported at the virtual National Kidney Foundation 2021 Spring Clinical Meetings.

Based on data from 224,157 patients with a hyperkalemia diagnosis seen at 860 hospitals in the Premier Healthcare Database during 2019-2020, Abiy Agiro, PhD, of AstraZeneca Pharmaceuticals in Wilmington, Delaware, and colleagues found that 61.9% of patients received no potassium binders, 30.7% SPS only, 4.0% patiromer only, 1.8% SZC only, and 0.7% SZC along with SPS or patiromer. Hyperkalemia was defined as a serum potassium level greater than 5.0 mmol/L or receipt of a potassium binder.

Chronic kidney disease, end-stage kidney disease, acute kidney injury, and dialysis therapy increased the odds of inpatient SZC use by 13%, 37%, 25%, and 20%, respectively, Dr Agiro’s team reported. Black vs White race increased the odds of SZC use by 22%. With respect to hospital characteristics, Western (vs Southern), rural (vs urban), and teaching (vs non-teaching) hospitals had 76%, 45%, and 37% higher likelihood of SZC prescription. Patients admitted through the emergency department were 18% more likely to receive SZC.

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Disclosure: This clinical trial was supported by AstraZeneca. Please see the original reference for a full list of authors’ disclosures.


Agiro A, Rosenthal N, Davis J, Davis T, Legg R, Amin A. Patterns of potassium binder use among hospitalized patients with hyperkalemia and factors associated with binder use. Presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings, April 6-10, 2021. Poster 259.