Patiromer, a sodium-free potassium binder, effectively treats hyperkalemia at any stage of nondialysis-dependent chronic kidney disease (CKD), a new study confirms.

Investigators pooled results from 3 randomized trials: AMETHYST-DN, OPAL-HK, and TOURMALINE. At baseline, patients had serum potassium concentrations exceeding 5.0 mEq/L and were treated with patiromer 8.4 to 33.6 g/day. Investigators stratified patients into 2 cohorts based on estimated glomerular filtration rate (eGFR): 209 patients (33%) with an eGFR of 45 mL/min/1.73 m2 or higher (mild/moderate CKD) and 417 patients (67%) with an eGFR less than 45 mL/min/1.73 m2 (severe/end-stage CKD). Nearly all patients were taking renin-angiotensin-aldosterone inhibitors (RAASi), which increase the risk for hyperkalemia. The KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guidelines recommend reducing RAASi doses or discontinuing these hypertension drugs only as a last resort.

Over 4 weeks, patiromer decreased mean serum potassium by 0.60 mEq/L in the mild/moderate CKD group and 0.84 mEq/L in the severe/end-stage CKD group, Hermann Haller, MD, of Medical School Hannover in Germany, and colleagues reported in Kidney 360.

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Drug-related adverse events occurred in 11.8% and 15.9% of the mild/moderate and severe/end-stage CKD groups, respectively. The most frequent adverse events in both groups were constipation (7.1% and 2.8%) and diarrhea (2.9% and 1.9%), respectively. Hypokalemia occurred in 2.0% vs 0.5%, respectively. Hypomagnesemia occurred in approximately 2% of each group. Patiromer discontinuation occurred in 6% and 2% of each group, respectively.

“This analysis showed that patiromer was generally well tolerated by patients with either mild/moderate or advanced/end-stage CKD over the 4-week treatment period, with a minimal risk of hypokalemia,” Dr Haller’s team wrote.

The post hoc nature of the study on patiromer for hyperkalemia across CKD stage and the lack of placebo-controlled groups limits interpretation of some results.

Disclosure: This research was supported by Vifor Pharma. Please see the original reference for a full list of disclosures.


Haller H, Bianchi S, McCafferty K, et al. Safety and efficacy of patiromer in hyperkalemic patients with CKD: a pooled analysis of three randomized trials. Kidney360 August 2022. doi:10.34067/KID.0001562022