The potassium binder patiromer may help treat acute hyperkalemia that is not life-threatening, a study suggests.

In 881 encounters, patients (mean age 67.4 years; 52.6% male; 38.4% Black) with a mean serum potassium level of 5.60 mEq/L were treated with a single dose of patiromer (8.4 g, 16.8 g, or 25.2 g) in emergency departments, inpatient units, and intensive care units at Montefiore Medical Center in the Bronx, New York, from 2018 to 2019. Only 2.2% of encounters involved a serum potassium level of 6.5 mEq/L or higher.

Serum potassium significantly decreased by a mean 0.50, 0.46, and 0.52 mEq/L from baseline within the first 6 hours, 6 to 12 hours, and 12 to 24 hours of patiromer administration, respectively, Katherine E. Di Palo, PharmD, and colleagues from Montefiore reported in JAMA Network Open. The mean relative reduction in serum potassium from baseline was 8.5%, 7.9%, and 9.0%, respectively.

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The lowest dose of patiromer (8.4 g) was used in 81.8% of encounters. Only 15.5% and 2.2% of encounters warranted 1 or 2 additional doses, respectively. A minority of encounters later involved insulin, furosemide, hemodialysis, or intravenous calcium.

Hypokalemia occurred in 0.2% of encounters at 24 hours after patiromer administration and hypomagnesemia occurred in 10%, the investigators reported.

“These findings suggest that patiromer monotherapy may be useful in an institutional setting for managing elevated potassium levels and minimizing the risk of hypokalemia associated with other potassium control measures,” Di Palo’s team concluded.

A 2019 study examined patiromer use among patients presenting to an emergency department with a serum potassium of 6.0 mEq/L or higher but no significant arrhythmia. This study expands patiromer’s potential benefit to the inpatient and intensive care settings.

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


Di Palo KE, Sinnett MJ, Goriacko P, et al. Assessment of patiromer monotherapy for hyperkalemia in an acute care setting. JAMA Netw Open. Published online January 26, 2022. doi:10.1001/jamanetworkopen.2021.45236