Comparison of Three Potassium Binders in Patients With Acute Hyperkalemia

Area of Science:

• Nephrology and Internal Medicine
• Clinical Pharmacology
• Cardiovascular Medicine

Background:

• Hyperkalemia is a prevalent electrolyte disorder in hospitalized patients, especially those with chronic kidney disease.
• Untreated hyperkalemia poses a risk of life-threatening cardiac arrhythmias.
• Sodium polystyrene sulfonate (SPS), patiromer, and sodium zirconium cyclosilicate (SZC) are common potassium binders, but direct comparisons in acute settings are limited.

Purpose of the Study:

• To compare the efficacy of SPS, patiromer, and SZC in reducing serum potassium levels within 24 hours in patients with acute hyperkalemia.
• To evaluate which potassium binder demonstrates superior performance in an acute care setting.

Main Methods:

• A retrospective cohort quality improvement study was conducted.
• Included 75 adult inpatients treated with SPS, SZC, or patiromer between 2021 and 2023.
• Serum potassium levels were analyzed pre- and post-treatment within 24 hours.

Main Results:

• All three potassium binders significantly reduced serum potassium levels (p<0.001).
• Sodium polystyrene sulfonate (SPS) and sodium zirconium cyclosilicate (SZC) showed greater efficacy than patiromer (p=0.001 and p=0.022, respectively), after controlling for baseline potassium, standard of care, and BMI.
• No significant difference in potassium reduction was observed between SPS and SZC (p=0.206).

Conclusions:

• SPS and SZC are more effective than patiromer in managing acute hyperkalemia.
• SZC presents a potentially preferable option for inpatient acute hyperkalemia management, considering the known safety profile of SPS.
• Further research may clarify long-term outcomes and safety profiles.