Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients

Csaba Kovesdy, Christopher G. Rowan, Ansgar Conrad, David M. Spiegel, Jeanene Fogli, Nina Oestreicher, Jeffrey J. Connaire, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticle

Abstract

Introduction: Patiromer is a potassium (K + ) binding polymer indicated for treating hyperkalemia. Among patients receiving chronic hemodialysis (HD), this study aimed to identify patient characteristics associated with patiromer initiation, describe patiromer utilization, and analyze serum K + pre- and post-patiromer initiation. Methods: In a retrospective cohort study, using electronic health record data from a large dialysis provider in the United States (study period: December 21, 2015, to December 20, 2016), HD patients were included who had a medication order for patiromer, sodium polystyrene sulfonate (SPS), or laboratory evidence of hyperkalemia (no K + binder [NoKb] cohort). The index date was the first order for patiromer/SPS, or the first K + ≥5.0 mEq/l (NoKb cohort), respectively. Using multivariable logistic regression, we identified patient characteristics associated with patiromer initiation. We evaluated patiromer utilization using Kaplan-Meier methodology and proportion of days covered. Serum K + concentrations were assessed pre- versus post-patiromer initiation. Results: Study cohorts included 527 (patiromer), 852 (SPS), and 8747 (NoKb) HD patients. Median follow-up was 141 days. Patiromer initiators were 2.6 times more likely to have had multiple prior episodes of hyperkalemia (odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.8–3.7). Most (61%) commenced patiromer on 8.4 g once daily; 60% of patients’ first patiromer order remained open after 180 days. Statistically significant reductions in K + , averaging approximately −0.5 mEq/l, were observed post-patiromer initiation (48% pre-patiromer vs. 22% post-patiromer had K + ≥6.0 mEq/l [P < 0.001]). Conclusion: Patiromer initiators receiving chronic hemodialysis had comparatively more severe, uncontrolled baseline hyperkalemia. Medication order data show long-term patiromer use was associated with significantly reduced K + .

Original languageEnglish (US)
Pages (from-to)301-309
Number of pages9
JournalKidney International Reports
Volume4
Issue number2
DOIs
StatePublished - Feb 1 2019

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Hyperkalemia
Renal Dialysis
Therapeutics
patiromer
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Nephrology

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Kovesdy, C., Rowan, C. G., Conrad, A., Spiegel, D. M., Fogli, J., Oestreicher, N., ... Winkelmayer, W. C. (2019). Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients. Kidney International Reports, 4(2), 301-309. https://doi.org/10.1016/j.ekir.2018.10.020

Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients. / Kovesdy, Csaba; Rowan, Christopher G.; Conrad, Ansgar; Spiegel, David M.; Fogli, Jeanene; Oestreicher, Nina; Connaire, Jeffrey J.; Winkelmayer, Wolfgang C.

In: Kidney International Reports, Vol. 4, No. 2, 01.02.2019, p. 301-309.

Research output: Contribution to journalArticle

Kovesdy, C, Rowan, CG, Conrad, A, Spiegel, DM, Fogli, J, Oestreicher, N, Connaire, JJ & Winkelmayer, WC 2019, 'Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients', Kidney International Reports, vol. 4, no. 2, pp. 301-309. https://doi.org/10.1016/j.ekir.2018.10.020
Kovesdy, Csaba ; Rowan, Christopher G. ; Conrad, Ansgar ; Spiegel, David M. ; Fogli, Jeanene ; Oestreicher, Nina ; Connaire, Jeffrey J. ; Winkelmayer, Wolfgang C. / Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients. In: Kidney International Reports. 2019 ; Vol. 4, No. 2. pp. 301-309.
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abstract = "Introduction: Patiromer is a potassium (K + ) binding polymer indicated for treating hyperkalemia. Among patients receiving chronic hemodialysis (HD), this study aimed to identify patient characteristics associated with patiromer initiation, describe patiromer utilization, and analyze serum K + pre- and post-patiromer initiation. Methods: In a retrospective cohort study, using electronic health record data from a large dialysis provider in the United States (study period: December 21, 2015, to December 20, 2016), HD patients were included who had a medication order for patiromer, sodium polystyrene sulfonate (SPS), or laboratory evidence of hyperkalemia (no K + binder [NoKb] cohort). The index date was the first order for patiromer/SPS, or the first K + ≥5.0 mEq/l (NoKb cohort), respectively. Using multivariable logistic regression, we identified patient characteristics associated with patiromer initiation. We evaluated patiromer utilization using Kaplan-Meier methodology and proportion of days covered. Serum K + concentrations were assessed pre- versus post-patiromer initiation. Results: Study cohorts included 527 (patiromer), 852 (SPS), and 8747 (NoKb) HD patients. Median follow-up was 141 days. Patiromer initiators were 2.6 times more likely to have had multiple prior episodes of hyperkalemia (odds ratio [OR]: 2.6; 95{\%} confidence interval [CI]: 1.8–3.7). Most (61{\%}) commenced patiromer on 8.4 g once daily; 60{\%} of patients’ first patiromer order remained open after 180 days. Statistically significant reductions in K + , averaging approximately −0.5 mEq/l, were observed post-patiromer initiation (48{\%} pre-patiromer vs. 22{\%} post-patiromer had K + ≥6.0 mEq/l [P < 0.001]). Conclusion: Patiromer initiators receiving chronic hemodialysis had comparatively more severe, uncontrolled baseline hyperkalemia. Medication order data show long-term patiromer use was associated with significantly reduced K + .",
author = "Csaba Kovesdy and Rowan, {Christopher G.} and Ansgar Conrad and Spiegel, {David M.} and Jeanene Fogli and Nina Oestreicher and Connaire, {Jeffrey J.} and Winkelmayer, {Wolfgang C.}",
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T1 - Real-World Evaluation of Patiromer for the Treatment of Hyperkalemia in Hemodialysis Patients

AU - Kovesdy, Csaba

AU - Rowan, Christopher G.

AU - Conrad, Ansgar

AU - Spiegel, David M.

AU - Fogli, Jeanene

AU - Oestreicher, Nina

AU - Connaire, Jeffrey J.

AU - Winkelmayer, Wolfgang C.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Introduction: Patiromer is a potassium (K + ) binding polymer indicated for treating hyperkalemia. Among patients receiving chronic hemodialysis (HD), this study aimed to identify patient characteristics associated with patiromer initiation, describe patiromer utilization, and analyze serum K + pre- and post-patiromer initiation. Methods: In a retrospective cohort study, using electronic health record data from a large dialysis provider in the United States (study period: December 21, 2015, to December 20, 2016), HD patients were included who had a medication order for patiromer, sodium polystyrene sulfonate (SPS), or laboratory evidence of hyperkalemia (no K + binder [NoKb] cohort). The index date was the first order for patiromer/SPS, or the first K + ≥5.0 mEq/l (NoKb cohort), respectively. Using multivariable logistic regression, we identified patient characteristics associated with patiromer initiation. We evaluated patiromer utilization using Kaplan-Meier methodology and proportion of days covered. Serum K + concentrations were assessed pre- versus post-patiromer initiation. Results: Study cohorts included 527 (patiromer), 852 (SPS), and 8747 (NoKb) HD patients. Median follow-up was 141 days. Patiromer initiators were 2.6 times more likely to have had multiple prior episodes of hyperkalemia (odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.8–3.7). Most (61%) commenced patiromer on 8.4 g once daily; 60% of patients’ first patiromer order remained open after 180 days. Statistically significant reductions in K + , averaging approximately −0.5 mEq/l, were observed post-patiromer initiation (48% pre-patiromer vs. 22% post-patiromer had K + ≥6.0 mEq/l [P < 0.001]). Conclusion: Patiromer initiators receiving chronic hemodialysis had comparatively more severe, uncontrolled baseline hyperkalemia. Medication order data show long-term patiromer use was associated with significantly reduced K + .

AB - Introduction: Patiromer is a potassium (K + ) binding polymer indicated for treating hyperkalemia. Among patients receiving chronic hemodialysis (HD), this study aimed to identify patient characteristics associated with patiromer initiation, describe patiromer utilization, and analyze serum K + pre- and post-patiromer initiation. Methods: In a retrospective cohort study, using electronic health record data from a large dialysis provider in the United States (study period: December 21, 2015, to December 20, 2016), HD patients were included who had a medication order for patiromer, sodium polystyrene sulfonate (SPS), or laboratory evidence of hyperkalemia (no K + binder [NoKb] cohort). The index date was the first order for patiromer/SPS, or the first K + ≥5.0 mEq/l (NoKb cohort), respectively. Using multivariable logistic regression, we identified patient characteristics associated with patiromer initiation. We evaluated patiromer utilization using Kaplan-Meier methodology and proportion of days covered. Serum K + concentrations were assessed pre- versus post-patiromer initiation. Results: Study cohorts included 527 (patiromer), 852 (SPS), and 8747 (NoKb) HD patients. Median follow-up was 141 days. Patiromer initiators were 2.6 times more likely to have had multiple prior episodes of hyperkalemia (odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.8–3.7). Most (61%) commenced patiromer on 8.4 g once daily; 60% of patients’ first patiromer order remained open after 180 days. Statistically significant reductions in K + , averaging approximately −0.5 mEq/l, were observed post-patiromer initiation (48% pre-patiromer vs. 22% post-patiromer had K + ≥6.0 mEq/l [P < 0.001]). Conclusion: Patiromer initiators receiving chronic hemodialysis had comparatively more severe, uncontrolled baseline hyperkalemia. Medication order data show long-term patiromer use was associated with significantly reduced K + .

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