Patiromer, a sodium-free potassium binder, is increasingly being used for chronic hyperkalemia management rather than episodic treatment, according to investigators.

In a retrospective, real-world study of 288 veterans (median age 70 years; 24% black) with hyperkalemia (5.1 mmol/L or more) initiating patiromer during 2016 to 2018, Csaba Kovesdy, MD, of the University of Tennessee Health Science Center in Memphis, and colleagues found multiple patiromer refills, at least 30 days supplied per dispensing, and half or more days covered by the medication. At 1, 3, and 6 months after patiromer initiation, the median proportion of days covered by the medication was 100%, 66%, and 44%, respectively.

Of the 288 patients, 95% had nondialysis chronic kidney disease, 83% had diabetes, and 32% had heart failure. For 96% of veterans the initial patiromer dosage was the recommended 8.4 g/d, whereas 4% started at 16.8 g/d. Dose increases were uncommon.

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Mean serum potassium levels declined significantly by a mean 1.0 mmol/L, in keeping with trial data, the investigators reported in Postgraduate Medicine. At 3 to 6 months, 71% of patiromer users had normokalemia and 95% had serum potassium less than 5.5 mmol/L.

During the 6-month study period, 80% of patients continued on renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, which is consistent with results from the AMBER trial.

“The observed patiromer utilization results suggest a potential paradigm shift toward chronic [hyperkalemia] management from acute or episodic treatment prior to the approval of patiromer,” Dr Kovesdy’s team stated. “The observed statistically significant [potassium] concentration reductions were consistent with well-controlled prospective clinical trials.”

Adverse events were not captured in the veterans database, which is a study limitation. The investigators urged further research with control groups and larger sample sizes to extend these findings.

Disclosure: This study was supported by Relypsa Pharma, the makers of patiromer (Veltassa®). Please see the original reference for a full list of authors’ disclosures.

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Kovesdy CP, Gosmanova EO, Woods SD, et al. Real-world management of hyperkalemia with patiromer among United States veterans [published online January 23, 2020]. Postgrad Med. doi: 10.1080/00325481.2019.1706920