Patiromer for Treatment of Hyperkalemia in the Emergency Department: A Pilot Study.

Abstract

Hyperkalemia is common and potentially life threatening. Patiromer is a Food and Drug Administration (FDA)-cleared oral potassium binder effective in the chronic treatment of hyperkalemia. The objective was to investigate the potential efficacy and safety of oral patiromer in treating acute hyperkalemia in the emergency department (ED). This is a single-center, randomized, open-label convenience sample pilot study in an inner-city ED. Adult patients with end-stage renal disease and a serum potassium level of≥6.0mEq/L were randomized to standard of care (SOC) or one dose of 25.2g oral patiromer plus SOC (PAT). Blood samples and electrocardiograms were collected at enrollment and at 1, 2, 4, and 6hours thereafter. The primary outcome was the difference in potassium between groups at 6hours. Secondary outcomes were the amount and number of times insulin and albuterol were given. Thirty patients were included in the final analysis, 15 in each group. There were no differences in age, sex, or baseline serum potassium. There was no difference in mean serum potassium between SOC and PAT groups at 6hours (6.32mEq/L, confidence interval [CI]= 6.0 to 6.63mEq/L vs. 5.81mEq/L, CI= 5.48 to 6.14mEq/L). However, 2hours posttreatment the serum potassium of the PAT group was lower than SOC group (5.90mEq/L, CI= 5.63 to 6.17mEq/L vs. 6.51mEq/L, CI= 6.25 to 6.78mEq/L) and also 0.61mEq/L lower than baseline. There were no differences in the amount or number of administrations of insulin or albuterol between groups, although the amount of albuterol used in the PAT group at 6hours was lower but not significant (median, 0mg vs. 12.5mg; p=0.097). There were no differences in adverse events between groups. In this open-label pilot study of severe hyperkalemia, a single dose of 25.2g of oral patiromer reduced serum potassium within 2hours but did not show a difference at 6hours. This is the first study showing that patiromer may have a role in the acute management of hyperkalemia; however, more rigorous studies are needed.