In this episode, I’ll discuss an article about patiromer for hyperkalemia in hospitalized patients.
Everybody dislikes using sodium polystyrene sulfate due to its potential for rare but serious side effects like intestinal necrosis. But newer agents for removing excess potassium from the body have limited data in patients with hyperkalemia in acute settings like the hospital.
I discussed some small studies back in episode 569 involving patiromer and sodium zirconium cyclosilicate but we finally have a larger study published about patiromer in JAMA.
Nearly 900 patients in a retrospective cohort who received patiromer for the inpatient treatment of non-severe hyperkalemia were analyzed.
Patients received one of 3 doses of patiromer: 8.4 g, 16.8 g, or 25.2 g.
The primary outcome was the mean absolute reduction in serum potassium level from baseline at 3 distinct time intervals after patiromer administration: 0 to 6 hours, greater than 6 to 12 hours, and greater than 12 to 24 hours.
The mean baseline serum potassium level for the cohort was 5.60 mEq/L. Within 6 hours of receiving patiromer, the mean reduction in potassium was 0.5 mEq/L.
The lowest dose was used in over 80% of cases and in 82.3% of cases no further doses of patiromer or any other potassium binder were required.
Hypokalemia occurred in just 2 cases for a rate of only 0.2% in the 24 hour period after patiromer was administered.
The authors concluded:
In this cohort study of patients with acute, non–life-threatening hyperkalemia, a single dose of patiromer was associated with a significant decrease in serum potassium levels and a low incidence of hypokalemia. 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
While this was a retrospective study with no control group, it provides useful information on how patiromer works in a real-world scenario of acute care patients with non-severe hyperkalemia.
Members of my Hospital Pharmacy Academy have access to practical training on dealing with hyperkalemia from a pharmacist’s point of view, along with hundreds of other resources to help in your practice. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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