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Study points to effectiveness of patiromer for the treatment of hyperkalemia
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A recently published study shows use of patiromer in a large, hemodialysis patient population proved effective in reducing hyperkalemia.
Researchers led by Csaba P. Kovesdy, MD, from the University of Tennessee Health Sciences Center looked at patients on hemodialysis treated at DaVita Kidney Care clinics from Dec. 21, 2015 to Dec.20, 2016 who had a medication order for patiromer (Veltassa, Relypsa Inc.), sodium polystyrene sulfonate (SPS) or had laboratory evidence of hyperkalemia (no K+ binder cohort). The study was conducted 1 year after patiromer received FDA approval.
Most patients in the study (82%) started the recommended dosing regimen of 8.4 g of patiromer once daily, and 89% did not change this dosing regimen during the review period. For patients in the patiromer and SPS cohorts, no restrictions were placed on baseline serum K+ concentration.
“However, consistent with other published studies of hyperkalemia, we conducted sensitivity analyses restricted to patients with baseline serum K+ concentrations 5 mEq,” the authors wrote. The study included 527 patients who used patiromer, 852 who used SPS and 8,747 who did not use a binder. The authors noted patiromer users were 2.6-times more likely to have had multiple prior episodes of hyperkalemia.
The results showed that for all patiromer initiators and patiromer initiators with a baseline K+ 5 mEq/L, the mean K+ concentration reductions were close to 0.5 mEq/L and 0.6 mEq/L, respectively.
“The largest K+ concentration reduction (>1 mEq/L reduction) was observed among patients whose baseline K+ was 6.5 mEq/L,” the authors wrote. “ ... The proportion of patiromer initiators with a K+ concentration 6 mEq/L was reduced from approximately 50% pre-patiromer to approximately 24% post-patiromer initiation. Among patiromer initiators with a baseline K+ 5 mEq/L, there was an approximately 30% reduction in the proportion of patients with a K+ concentration 6 mEq/L.”
The proportion of patients with a K+ concentration 6 mEq/L was reduced from approximately 64% at baseline to 23% following patiromer initiation.
“This study provides an early snapshot of patiromer use in real-world practice in patients receiving chronic HD,” the authors wrote. “Patients initiating patiromer had more severe and recurrent hyperkalemia, failed attempts to control hyperkalemia with SPS, yet the majority of these patients had significant K+ reductions following patiromer initiation. Notably, the relative proportion of patients with severe hyperkalemia (ie, 6 mEq/L) was reduced by more than 50% following patiromer initiation.”
The authors agreed that further research was warranted to investigate whether patiromer use and subsequent potassium control yields better patient outcomes.
Disclosures: This study was funded by Relypsa Inc., a Vifor Pharma Group Company, which sells patiromer. Three authors of the paper are employed by the company and were involved in data acquisition and data analysis/interpretation during manuscript drafting and revisions. Two authors have provided consulting services to Relypsa Inc., and a fifth author was a Relypsa employee at the time of the study. Editorial support services were funded by Relypsa Inc.
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Kovesdy CP, et al. Kidney International Reports, 2018;doi:10.1016/j.ekir.2018.10.020.
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