title: Patiromer Decreases Serum Potassium and Phosphate Levels in Patients on Hemodialysis.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  In 6 hyperkalemic HD patients, patiromer decreased serum K and P levels and increased fecal K.
authors: Department of Medicine, University of Rochester, Rochester, N.Y., USA.
authors: David A
authors: DA
authors: Bushinsky
authors: Patrick
authors: P
authors: Rossignol
authors: David M
authors: DM
authors: Spiegel
authors: Wade W
authors: WW
authors: Benton
authors: Jinwei
authors: J
authors: Yuan
authors: Geoffrey A
authors: GA
authors: Block
authors: Christopher S
authors: CS
authors: Wilcox
authors: Rajiv
authors: R
authors: Agarwal
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000494:pharmacology / Q000627:therapeutic use*; D006435:Renal Dialysis
chemical_list: D011108:Polymers; C568789:patiromer