Patiromer: a significant advance in the management of hyperkalemia

The U.S. Food and Drug Administration (FDA) approved patiromer to treat hyperkalemia on October 21, 2015, making it the first agent approved for this condition in 50 years. Patiromer was developed by Relypsa, Inc. The active ingredient is patiromer sorbitex calcium which consists of the active moiety, patiromer, a nonabsorbed potassium-binding polymer, and a calcium-sorbitol counterion. In the colon, patiromer exchanges calcium for potassium thus causing a fall in serum potassium. Trials have shown that patiromer reduces serum potassium in patients with mild, moderate and moderate to severe hyperkalemia to the normal range. It has also been used successfully in patients with chronic kidney disease and/or heart failure. It has also allowed the use of the mineralocorticoid antagonist spironolactone in full dosage in patients with chronic kidney disease and/or heart failure who were already receiving a renin-angiotensin-aldosterone system inhibitor. Adverse effects have mostly been gastrointestinal in nature and have not caused patients to discontinue treatment in unacceptable numbers.