Along with reducing serum potassium levels, patiromer may reduce elevated serum phosphate levels in patients with chronic kidney disease, investigators suggested at the American Society of Nephrology’s Kidney Week 2021.

In a post hoc analysis of pooled data from 3 trials (AMETHYST-DN, OPAL-HK, and TOURMALINE), 86 of 578 patients with hyperkalemia (14.9%) had concomitant hyperphosphatemia. Among patients with baseline serum phosphate levels above 4.5 mg/dL, mean serum phosphate levels decreased significantly from 5.0 to 4.4 mg/dL and mean serum potassium levels from 5.5 to 4.8 mEq/L over 2 or 4 weeks of patiromer treatment, David A. Bushinsky, MD, of the University of Rochester in New York, reported during an oral presentation. Phosphate binder use was not permitted during the trials.

The most frequent adverse events (AEs) were constipation (9%) and diarrhea (7%) of mostly mild to moderate severity. AEs leading to study discontinuation occurred in 3.5% of patients.

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Patiromer exchanges calcium for potassium ions in the gastrointestinal tract, and the investigators think the released calcium binds to intestinal phosphate, according to Dr Bushinsky.

“The ability of patiromer to normalize serum phosphate may be therapeutically useful in hyperkalemic patients with chronic kidney disease who have hyperphosphatemia,” he concluded.

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


Bushinsky DA, Epstein M, Budden JJ, Yuan J, Kalra PA. Effects of patiromer on serum phosphate over 4 weeks of treatment in hyperkalemic patients with hyperphosphatemia: pooled analysis of the AMETHYST-DN, OPAL-HK, and TOURMALINE Trials. Presented at: Kidney Week 2021, November 2-7, 2021. Poster PO0537.