Cardiovascular - Clinical Research


408 - Patiromer for Treatment of Hyperkalemia in the Emergency Department: A Pilot Study

Friday, May 18
9:50 AM - 9:58 AM
Location: 102: First Floor
CE Hours: 0.16

Background: Hyperkalemia is common and potentially life threatening. Patiromer is an FDA cleared oral potassium binder effective in the chronic treatment of hyperkalemia. Our goal is to investigate the potential efficacy and safety of oral patiromer in treating acute hyperkalemia in the emergency department (ED). Methods: This is a single-center, randomzed, open label convenience sample pilot study at an academic ED. Patients with potassium (K) ≥6.0 mEq/L were randomized to standard of care (SOC) or SOC plus one dose of 25.2g patiromer (PAT). SOC was per the treating physician. Labs and electrocardiograms (ECGs) were collected at enrollment and at 1, 2, 4, and 6 hours thereafter. Patients were excluded for clinically significant arrhythmia on initial ECG, allergy to patiromer, or if they had received any oral K binder. The primary outcome was the change in K between SOC and PAT groups. Outcomes were analyzed with Wilcoxon rank sum and log-linear regression analysis. Adverse event rates were analyzed using Chi squared test. Results: Thirty patients were enrolled; 15 in each group. There were no differences in age, sex, or race between the groups, however, SOC patients had higher baseline K; 6.7 (95% CI 6.2, 6.7) vs 6.4 mEq/L (95% CI 6.5, 6.9), respectively; p < 0.05. There was no differences in the change in K between PAT and SOC groups at 4 hours; -0.69 (95% CI -1.05, -0.33), and -0.60 mEq/L (95% CI -1.01, -0.19), or 6 hours; -0.59 (95% CI -1.20, 0.03) and -0.42 mEq/L (95% CI -0.67, -0.18), respectively. However, PAT patients required numerically fewer K-lowering interventions at 4 hours vs SOC; 0.8 (95% CI 0.9, 2.4) vs 1.7 (95% CI 0.3, 1.3), respectively, p < 0.05. PAT patients also required less albuterol at 4 hours; 3.3 mg (95% CI 0.7, 5.9) vs 11.2 mg (95% CI 4.9, 17.4), respectively, p = 0.05. There were no differences in adverse events between groups<.br /> Conclusion: A single dose of 25.2g of oral patiromer may reduce the number of interventions needed to treat hyperkalemia in the ED. This study is limited by a small sample size and heterogeneity in provider management strategies for acute hyperkalemia. Patiromer may have a role for acute management of hyperkalemia in the ED, however future research is needed.

Mengyang Liu

Baylor College of Medicine

Mengyang Liu, MD, is an emergency medicine resident at Baylor College of Medicine in Houston Texas.


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Rafique Zubaid

Baylor College of Medicine, Ben Taub Hospital


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W. Frank Peacock


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Send Email for Daren Beam


408 - Patiromer for Treatment of Hyperkalemia in the Emergency Department: A Pilot Study

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