Untreated chronic
hyperkalemia is associated with an increased risk of mortality. Novel
potassium binders (e.g.,
patiromer) are new additions to the clinician's armamentarium. Prior to their approval, clinicians often considered trialing
sodium polystyrene sulfonate. The study objective was to assess
patiromer utilization and associated changes in serum
potassium (K+) in US veterans with prior
sodium polystyrene sulfonate exposure. This was a real-world observational study of US veterans with
chronic kidney disease and a baseline K+ ≥ 5.1 mEq/L, initiated on
patiromer between January 1, 2016, and February 28, 2021. The primary endpoints were
patiromer utilization (dispensations and treatment courses), and K+ change at 30-, 91-, and 182-day follow-up (FU) intervals.
Patiromer utilization was described using Kaplan-Meier probabilities and the proportion of days covered. Descriptive changes in population average K+ were obtained from a pre-post design using single-arm within-patient pre-post lab pairs and paired t tests. Two hundred five veterans met the study criteria. We observed an average of 1.25 (95% CI, 1.19-1.31) treatment courses and a median
treatment duration of 64 days. Fifty veterans (24.4%) had >1 course, and 17.6% of patients remained on their initial
patiromer treatment course until the end of the 180-day FU. The mean K+ value was 5.73 mEq/L (5.66-5.79) at baseline, 4.95 mEq/L (95% CI, 4.86-5.05) at the 30-day interval, 4.93 mEq/L (95% CI, 4.84-5.03) at the 91-day interval, and 4.9 mEq/L (95% CI, 4.8-4.99) at the 182-day interval. Novel
potassium binders (e.g.,
patiromer) are newer chronic
hyperkalemia management tools for clinicians. The average population K+ decreased to <5.1 mEq/L at all follow-up intervals.
Patiromer appeared to be well tolerated with nearly 18% of patients remaining on their initial treatment course during the entire 180-day FU period. The median
treatment duration was 64 days and approximately 24% of patients initiated a second course during FU.