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. 2022 Oct 11;16(1):176-183.
doi: 10.1093/ckj/sfac209. eCollection 2023 Jan.

Patiromer utilization in patients with advanced chronic kidney disease under nephrology care in Germany

Roberto Pecoits-Filho  1   2 , Keith McCullough  1 , Daniel Muenz  1 , Carol Moreno Quinn  3 , Jeff Budden  4 , John Golden  5 , Antonio Ramirez de Arellano  3 , Frank-Peter Tillmann  6 , Johannes Duttlinger  7 , Viviane Calice-Silva  8   9 , Ziad A Massy  10   11   12 , Brian Bieber  1 , Bruce M Robinson  1 , Danilo Fliser  13 , Helmut Reichel  14 ; CKDopps Investigators*
Collaborators, Affiliations

Patiromer utilization in patients with advanced chronic kidney disease under nephrology care in Germany

Roberto Pecoits-Filho et al. Clin Kidney J. .

Abstract

Background: Hyperkalemia (HK) is a frequent condition in patients with chronic kidney disease (CKD) that is associated with high morbidity and mortality. Patiromer has recently been introduced as a potassium binder. Data on patiromer use in patients with CKD in the real-world setting in Europe are lacking. We describe time to discontinuation and changes in serum potassium levels among German CKD stage 3-5 patients starting patiromer.

Methods: Duration of patiromer use was estimated by Kaplan-Meier curve, starting at patiromer initiation and censoring for death, dialysis, transplant or loss to follow-up. Serum potassium levels and renin-angiotensin-aldosterone system inhibitor (RAASi) use are described at baseline and during follow-up, restricted to patients remaining on patiromer.

Results: We identified 140 patiromer users within our analysis sample [81% CKD stage 4/5, 83% receiving RAASi, and median K+ 5.7 (5.4, 6.3) mmol/L]. Thirty percent of patiromer users had prior history of polystyrene sulfonate use. Overall, 95% of patiromer users stayed on treatment past 1 month, with 53% continuing for over a year. Mean serum potassium levels decreased after patiromer initiation and remained stable under treatment during follow-up (up to 180 days). Among these patients, 73%-82% used RAASis during the time periods before and after patiromer initiation, with no obvious trend indicating discontinuation.

Conclusion: Real-world evidence of patiromer use in Germany shows that, in line with what has been observed in clinical trials, patients on patiromer have a reduction in serum potassium when used long-term. Moreover, most patients on patiromer do not discontinue treatment prior to 1 year after initiation.

Keywords: chronic kidney disease; hyperkalemia; patiromer; potassium binders.

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Figures

Figure 1:
Figure 1:
STROBE inclusion/exclusion chart.
Figure 2:
Figure 2:
Time to discontinuation of patiromer.Note: 12 patients omitted due to insufficient follow-up data after patiromer initiation.
Figure 3:
Figure 3:
Reduction in serum potassium after patiromer start.
Figure 4:
Figure 4:
RAASi use by time period after patiromer initiation baseline.
See this image and copyright information in PMC

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