Patiromer Decreases Serum Potassium and Phosphate Levels in Patients on Hemodialysis

David A. Bushinsky, Patrick Rossignol, David M. Spiegel, Wade W. Benton, Jinwei Yuan, Geoffrey A. Block, Christopher S. Wilcox, Rajiv Agarwal

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Background: Persistent hyperkalemia (serum potassium (K) ≥5.5 mEq/l) is a common condition in hemodialysis (HD) patients, is associated with increased mortality, and treatment options are limited. The effect of patiromer, a gastrointestinal K binder, on serum K was examined in HD patients. Methods: Six hyperkalemic HD patients (5 anuric) were admitted to clinical research units for 15 days (1 pretreatment week and 1 patiromer treatment week) and they received a controlled diet with identical meals on corresponding days of pretreatment and treatment weeks. Phosphate (P) binders were discontinued on admission. Patiromer, 12.6 g daily (divided 4.2 g TID with meals), was started on the Monday morning following the last pretreatment week blood sampling. Serum and 24-hour stool samples were collected daily. Results: Mean ± SE serum K decreased (maximum change per corresponding day, 0.6 ± 0.2 mEq/l, p = 0.009) and fecal K increased 58% on patiromer compared with the pretreatment week. During the pretreatment week, 69.0, 47.6, and 11.9% of patients' serum K values were ≥5.5, ≥6.0, and ≥6.5 mEq/l, respectively. This was reduced to 38.1% (p = 0.009), 11.9% (p < 0.001), and 2.4% (p = 0.2) on patiromer. Following P binder discontinuation, the long interdialytic interval mean ± SE serum P numerically increased from 5.8 ± 0.4 to 7.0 ± 0.5 mg/dl (p = 0.06). On patiromer, P decreased from 7.0 ± 0.5 to 6.2 ± 0.5 mg/dl (p = 0.04). While on patiromer, fecal P numerically increased by 112 ± 72 mg/day (17%; p = 0.1792; range -148 to 344 mg/day). No patient discontinued patiromer because of adverse events (AEs); none had serious AEs. Conclusions: In 6 hyperkalemic HD patients, patiromer decreased serum K and P levels and increased fecal K.

Original languageEnglish (US)
Pages (from-to)404-410
Number of pages7
JournalAmerican journal of nephrology
Volume44
Issue number5
DOIs
StatePublished - Nov 1 2016

Keywords

  • End-stage renal disease
  • Hemodialysis
  • Hyperkalemia
  • Patiromer
  • Phosphate
  • Potassium

ASJC Scopus subject areas

  • Nephrology

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    Bushinsky, D. A., Rossignol, P., Spiegel, D. M., Benton, W. W., Yuan, J., Block, G. A., Wilcox, C. S., & Agarwal, R. (2016). Patiromer Decreases Serum Potassium and Phosphate Levels in Patients on Hemodialysis. American journal of nephrology, 44(5), 404-410. https://doi.org/10.1159/000451067