The potassium binder patiromer might have a role in the acute management of hyperkalemia, results of a pilot study suggest.

Zubaid Rafique, MD, of Baylor College of Medicine in Houston, and colleagues randomly assigned 43 adult patients with end-stage renal disease and severe hyperkalemia to receive standard care or maximum-dose patiromer (a single oral dose of 25.2 g) plus standard care. Patients presented to a single emergency department with a serum potassium of 6.0 mEq/L or higher, but they had no significant arrhythmia on initial electrocardiogram and had at least a 4-hour wait for hemodialysis. The 2 groups did not differ significantly in age, sex, baseline serum potassium, magnesium, or glucose.

Maximum-dose patiromer with standard care reduced serum potassium within 2 hours but did not have a sustained effect at 6 hours compared with standard care alone, according to results published in Academic Emergency Medicine. Mean serum potassium at 2 hours was 5.90 vs 6.51 mEq/L for the patiromer and standard care groups, respectively, but 6.32 vs 5.81 mE/L, respectively, at 6 hours. For the patiromer group, mean potassium was significantly lower at each time point — 2 hours (-0.52 mEq/L), 4 hours (-0.69 mEq/L), and 6 hours (-0.61 mEq/L) — compared with baseline.  

The amount of insulin or albuterol received and the number of interventions did not differ significantly between groups.

With respect to adverse events, 1 patiromer and 2 standard-care-only patients reported nausea, vomiting, or gastrointestinal discomfort. Three patients experienced hypoglycemia in each group and received dextrose. No patient had hypomagnesemia.

The study was limited by the small sample size and by the fact that standard of care was variably defined according to individual practice pattern or hospital protocol.

“Our results are encouraging and support the need for a larger, definitive, multicenter study to establish the role of patiromer in the acute management of hyperkalemia,” Dr Rafique’s team stated.

The study was funded by Relypsa Inc, the makers of patiromer (Veltassa).

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Reference

Rafique Z, Liu M, Staggers KA, et al. Patiromer for treatment of hyperkalemia in the emergency department: A pilot study [published online October 10, 2019]. Acad Emerg Med. doi:10.1111/acem.13868.