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. 2025 May 10;6(4):100158.
doi: 10.1016/j.acepjo.2025.100158. eCollection 2025 Aug.

Outcomes and Resource Utilization in Hyperkalemic Emergency Department Patients Treated With Patiromer or Sodium Zirconium Cyclosilicate

William Frank Peacock  1 , Zubaid Rafique  1 , Julie Gayle  2 , James Neuenschwander  3 , Harold Brown  2 , Jennifer Kammerer  4 , Jeffrey Budden  4 , Ning Rosenthal  2
Affiliations

Outcomes and Resource Utilization in Hyperkalemic Emergency Department Patients Treated With Patiromer or Sodium Zirconium Cyclosilicate

William Frank Peacock et al. J Am Coll Emerg Physicians Open. .

Abstract

Objectives: Hyperkalemia (HK) is a life-threatening condition commonly treated in emergency department (ED). Real-world outcomes associated with ED administration of potassium binders are limited. This study assessed ED discharge disposition and resource utilization in hyperkalemic ED patients treated with patiromer or sodium zirconium cyclosilicate (SZC).

Methods: We performed a retrospective cohort study using discharge data from 230 hospitals in the Premier PINC AI Healthcare Database. ED patients were included if they were ≥18 years old, had potassium ≥5 mEq/L, and received patiromer/SZC during January 1, 2019 to December 31, 2021. Descriptive statistics and multivariable logistic regression analysis were used to compare outcomes between binder cohorts.

Results: Of 18,248 patients meeting selection criteria, 6480 and 11,768 received patiromer and SZC, respectively. Compared with patients receiving SZC, patients receiving patiromer were older, more likely to be White and Hispanic, with Medicare as primary insurance, and had a higher mean Charlson-Deyo Comorbidity Index. Adjusted analysis showed that the odds of being admitted to an inpatient ward were similar between cohorts (adjusted odds ratio [aOR] = 1.09; 95% CI: 0.96, 1.23). Patients receiving patiromer had lower mortality during index visit (12.0% vs 16.3%; aOR = 0.85; 95% CI: 0.76, 0.95), but higher odds of all-cause hospitalization (3.0% vs 0.8%; aOR = 3.54; 95% CI: 2.73, 4.59) and hyperkalemia-related hospitalization (1.1% vs 0.3%; aOR = 3.28; 95% CI: 2.15, 5.00) during 30-day follow-up than patients receiving SZC.

Conclusion: This large nationally representative sample of US ED patients showed that patiromer and SZC treatment had similar discharge dispositions to inpatient ward/home. Patients receiving patiromer had lower in-hospital mortality. Patients receiving SZC had lower 30-day all-cause and hyperkalemia-related hospitalization risks.

Keywords: emergency department; health care resource utilization; hyperkalemia; patiromer; potassium binders; sodium zirconium cyclosilicate.

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Conflict of interest statement

WFP received research grants from Abbott, Brainbox, Quidel, Roche, Siemens; served as a consultant to Abbott, AstraZeneca, Biocogniv, Brainbox, Bristol Meyers Squibb, Instrument Labs, Janssen, Osler, Quidel, Roche, Siemens, Spinchip, CSL Vifor; and held stock/ownership of AseptiScope Inc, Brainbox Inc, Biocogniv, Inc, Braincheck Inc, Coagulo Inc, Comprehensive Research Associates LLC, Comprehensive Research Management Inc, Emergencies in Medicine LLC, Fast Inc, Forrest Devices, Ischemia DX LLC, Lucia Inc, Prevencio Inc, RCE Technologies, ROMTech, ScPharma, Trivirum Inc, and Upstream Inc. ZR reports grants and personal fees from AstraZeneca; grants and personal fees from CSL Vifor, outside the submitted work. JN serves as a consultant and on the speaker bureau at AstraZeneca, Janssen Pharmaceutical, ThermoFisher, Fisher, and Paykel; a consultant at Pfizer Inc; a speaker at Abbott; a research consultant at Siemens, Bridgesource, and CSL Behring; and owner of Asceptoscope. JG, HB, and NR are stockholders of Premier Inc. JK and JB are stockholders of CSL Vifor.

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