Patiromer for the treatment of hyperkalemia

ABSTRACT

Introduction

Hyperkalemia is a chronic and life-threatening electrolyte disorder that affects millions of patients around the world with decreased kidney function, hypertension, and heart failure. Recently newer oral potassium-binding agents have been approved for clinical use, as an alternative to the decades long use of sodium polystyrene sulfonate. This review will focus on the patiromer and its use in reducing hyperkalemia.

Areas covered

Pubmed was used to search from 1960 to 2020 on free subject terms: Hyperkalemia, Potassium, Patiromer, Veltassa, Kayexalate, Sodium polystyrene sulfonate, and Sodium Zirconium cyclosilicate. The authors have reviewed the literature and summarized the most salient elements in regards to patiromer.

Expert opinion

Patiromer has been available on the US market since 2015 when approved by the FDA for clinical use. Clinical trials monitoring patient use for up to 1 year have shown clinically meaningful potassium reductions, sustained normokalemia, high tolerability, and without major serious adverse events. Patiromer is available to all patients experiencing hyperkalemia, no matter the disease state leading to the condition. It is likely this newer oral potassium-binding agent will help change how patients with hyperkalemia are treated in regards to sudden and chronic medical conditions.

KEYWORDS:

• Dialysis
• heart failure
• hyperkalemia
• hypertension
• patiromer
• potassium
• kidney disease

Article highlights box

• Patiromer is a sodium-free, oral polymer that is indicated for the treatment of hyperkalemia

• Patiromer polymer is bound with calcium which is released in the colon in exchange for binding potassium

• Clinical trials including PEARL-HF, AMETHYST-DN, and AMBER have proven with chronic use patiromer is safe and effective in reducing and controlling high potassium in the serum

• Patiromer is dosed as a once-daily medication at 8.4, 16.8, or 25.2 grams available in single-use packets

• Common adverse reactions include constipation, diarrhea, hypomagnesemia, and hypokalemia

Declaration of interest

G Colbert declared that they are on the Relypsa Vifor speaker bureau and the Astra Zeneca advisory board. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosure

A reviewer on this manuscript has disclosed being a consultant for Relypsa/Vifor, Astra Zeneca, and Ardelyx. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.