Efficacy of Patiromer in Treatment of Long Inter-Dialytic Interval Hyperkalemia in Potassium-Rich Diet Populations Undergoing Intermittent Hemodialysis.

Abstract

Background: Hyperkalemia after a Long Interdialytic Interval (LIDI) is a potentially life-threatening complication in patients undergoing intermittent hemodialysis. The risk is exacerbated especially in populations known for Potassium-rich dietary habits and cultural tradition of weekend gatherings. Patiromer is a potassium binder that helps treat Hyperkalemia. This study aimed to evaluate the efficacy of Patiromer in the management of LIDI Hyperkalemia in patients with ESKD on Intermittent Hemodialysis, with Potassium rich dietary habits as in Saudi Arabia.

Methods: Adult patients who had completed 3 months on Intermittent Hemodialysis, were screened for LIDI hyperkalemia pre dialysis (serum K >5.3 mmol/L).Patients with hyperkalemia were prescribed Patiromer on days off Hemodialysis during the LIDI (Thursday and Friday for Saturday group; Friday and Saturday for Sunday group). Pre HD serum potassium levels were monitored after the LIDI at weeks 1, 2, 4, 8, 12, 24, and 52. Patient Compliance was ensured through telephonic communication with the patient or the care giver.

Results: Among the 127 patients on Intermittent Hemodialysis, 58 were identified with LIDI hyperkalemia out of whom 52 patients completed one year follow-up. 36 had serum K 5.3-5.9 mmol/l, 11 had serum K 6-6.5 mmol/l, 5 had serum K 6.5 mmol/l and above. Patiromer therapy resulted in a mean serum potassium reduction of 0.8-2.5 mmol/L, with a sustained average reduction of 1.57 mmol/L observed over 52 weeks. The treatment was well tolerated, with no drop outs reported due to side effects.

Conclusion: Patiromer demonstrated sustained efficacy and excellent tolerance in preventing hyperkalemia after the LIDI in our potassium rich diet population undergoing Intermittent Hemodialysis.