Patiromer reduced serum phosphorous, serum potassium in patients with CKD
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Key takeaways:
- Patiromer was generally well tolerated.
- Patiromer reduced serum phosphorous and serum potassium to a normal range.
Treating patients with chronic kidney disease and hyperkalemia with patiromer reduced serum phosphorus and serum potassium levels during a 2-week period, according to data published in the American Journal of Kidney Diseases.
Further, the reductions were sustained for 4 weeks.
“Different published clinical trials (AMETHYST-DN, OPAL-HK, and TOURMALINE) have shown the efficacy and safety of patiromer for the treatment of hyperkalemia in patients eligible for treatment with renin-angiotensin-aldosterone system inhibitors,” David A. Bushinsky, MD, from the University of Rochester School of Medicine and Dentistry, and colleagues wrote. They added, “Patients with reduced eGFR are also at risk of hyperkalemia and the risk for both hyperphosphatemia and hyperkalemia increases as eGFR declines. Consequently, a potassium binder that could treat both elevated serum potassium and elevated serum phosphorous could be beneficial in patients with CKD and these two electrolyte abnormalities. However, to our knowledge, there are no published reports that assess the proportion of patients with hyperkalemia who also have elevated serum phosphorus.”
In a post-hoc pooled analysis of the AMETHYST-DN, OPAL-HK and TOURMALINE trials, researchers examined data of 578 patients with CKD and hyperkalemia. Specifically, researchers investigated how 8.4 grams to 33.6 grams of patiromer treatment a day impacted the serum phosphorus, serum potassium, serum calcium and serum magnesium levels among patients with hyperkalemia during a 4-week period.
At baseline, 86 patients had hyperphosphatemia. Of these, 65 patients had stage 4 or 5 CKD. Using descriptive statistics, researchers summarized data on the study outcomes of all three trials.
Following 4 weeks of patiromer treatment, the mean reduction in serum phosphorous and serum potassium was –0.62 mg/dL and –0.71 mEq/L, respectively, among patients with elevated levels at baseline. Researchers observed a mean reduction of –0.25 mg/dL in serum magnesium, but no change in serum calcium.
“In patients treated with patiromer, there was a reduction in both [serum potassium and serum phosphorous] levels to within the normal range after 2 weeks, which was sustained for up to 4 weeks,” the researchers wrote. “Patiromer was well tolerated in patients with hyperkalemia and [non-dialysis] CKD, and the most common adverse events were mild or moderate gastrointestinal events. Future placebo-controlled trials, in both [non-dialysis] and stage 5 CKD, are needed to assess the ability of patiromer to concomitantly normalize serum phosphorous in hyperkalemic patients with CKD to manage hyperphosphatemia.”
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