Comparison of Patiromer to Sodium Polystyrene Sulfonate in Acute Hyperkalemia. (June 2022)

• Record Type: Journal Article
• Authors: Nguyen, Peter T.; Kataria, Vivek K.; Sam, Teena R.; Hooper, Katie; Mehta, Ankit N.
• Is Part Of: Hospital pharmacy. Volume 57:Number 3(2022)
• Page Start: 359
• Page End: 364
• Publication Date: 2022-06
• Subjects: CQI -- drug/medical use evaluation -- fluid and electrolyte disorders; Hospital pharmacies -- Periodicals; Pharmacy Service, Hospital; Hospital pharmacies; Periodicals; Periodicals; 615.1
• DOI: 10.1177/00185787211037552
• Languages: English
• ISSNs: 0018-5787

Abstract

Background: Patiromer and sodium polystyrene sulfonate (SPS) are cation-exchangers approved for the treatment of chronic hyperkalemia. Data regarding their efficacy acutely is lacking. Despite this, both drugs are frequently used in the emergent setting.Objective: The purpose of this study was to compare the potassium reduction of patiromer to SPS within 6 to 24 hours following a single dose.Methods: This retrospective quality improvement project included hyperkalemic patients receiving 1 dose of patiromer or SPS and had a second potassium level drawn in 6 to 24 hours. Doses of 8.4 g of patiromer and 15 g of SPS were considered "low dose" while 16.8 g of patiromer and 30 g of SPS were considered "high dose." The presence of a dose-response relationship was assessed through a linear regression analysis.Results: Mean (SD) potassium reduction was higher in SPS than patiromer [0.76 (0.63) mEq/L vs 0.32 (0.65) mEq/L, ( P = .001)]. A dose response relationship was not demonstrated in low versus high dose groups [−0.21 (0.14), P = .13] and CKD, ESRD, and renal transplant patients when compared to patients with normal renal function [0.11 (0.17), P = .51, −0.07 (0.19), P = −0.07 (0.19), P = .73, and −0.10 (0.22), P = .65].Conclusions: This study suggests a clinically significant reduction in potassium with SPS compared to patiromer. Although SPS was successful in demonstrating this outcome, due to well-documented adverse reactions in the literature and a time to onset of 6 hours, it cannot be recommended for use in acute hyperkalemia either.