Real-world management of hyperkalemia with patiromer among United States Veterans

Objective: Patiromer is a sodium-free, non-absorbed, potassium (K⁺) binder approved for the treatment of hyperkalemia (HK). Among US Veterans with HK, this retrospective, observational cohort study evaluated patiromer utilization, RAASi continuation, and K⁺ concentration change following patiromer initiation.

Methods: Using data from the Veterans Affairs Corporate Data Warehouse, Veterans with HK (K⁺ ≥5.1 mmol/L) were included upon patiromer initiation (index date) during the study period (1/2016–8/2018). All patients had heart failure (HF), diabetes, or chronic kidney disease (CKD). Patients with end-stage renal disease were excluded. The following outcomes were assessed within 6-months post-patiromer initiation: patiromer utilization (using proportion of days covered); K⁺ concentration change (pre- vs post-initiation); and RAASi continuation.

Results: 288 Veterans with HK were included. Baseline characteristics were: median age 70 years, African-American race 24%, diabetes 83%, HF 32%, CKD 95%, and median K⁺ concentration 5.7 mmol/L. At 1, 3, and 6 months post-index, the median patiromer PDC was 100%, 66%, and 44%, respectively. K⁺ concentration reductions post-patiromer initiation were, on average, – 1.0 mmol/L (P < 0.001). At 3–6 months, 71% of patiromer initiators had K⁺ <5.1 mmol/L and 95% had K⁺ <5.5 mmol/L. RAASi therapy was continued in >80%–90% of patiromer-treated patients.

Conclusions: The real-world utilization results suggest patiromer is used for the chronic management of HK. Clinically relevant K⁺ concentration reductions were observed at all study time points. The successful management of HK may have contributed to the observed high rate of RAASi therapy continuation. Further research is warranted to corroborate and extend these findings.