Patiromer: A Review in Hyperkalaemia

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Hyperkalemia is a serious condition, often associated with chronic kidney disease (CKD) and heart failure (HF).
• Renin-angiotensin-aldosterone system (RAAS) inhibitors, crucial for managing CKD and HF, can increase the risk of hyperkalemia.
• Effective management of hyperkalemia is essential to allow patients to remain on guideline-directed medical therapy.

Purpose of the Study:

• To evaluate the efficacy and safety of patiromer for the treatment of hyperkalemia in adults.
• To assess patiromer's ability to facilitate the use of RAAS inhibitors in patients with CKD and/or diabetic nephropathy.
• To determine patiromer's role in managing hyperkalemia in patients with heart failure.

Main Methods:

• Patiromer is an oral, non-absorbed potassium-binding polymer.
• It exchanges calcium for potassium in the gastrointestinal tract, increasing fecal potassium excretion.
• Clinical trials assessed serum potassium reduction, risk of recurrent hyperkalemia, and tolerability.

Main Results:

• Patiromer significantly reduced serum potassium levels in patients with hyperkalemia.
• It allowed the majority of patients with CKD and/or diabetic nephropathy to continue RAAS inhibitor therapy for up to 52 weeks.
• Patiromer maintained normokalemia in HF patients, enabling spironolactone use and up-titration, with a low risk of hypokalemia.

Conclusions:

• Oral patiromer is an effective and well-tolerated treatment for long-term hyperkalemia management.
• It provides a valuable option for patients requiring RAAS inhibitors or those with HF and hyperkalemia risk.
• Patiromer facilitates optimal medical therapy in patients with CKD and/or HF by managing hyperkalemia.