Comparison of Patiromer to Sodium Polystyrene Sulfonate in Acute Hyperkalemia.

Patiromer and sodium polystyrene sulfonate (SPS) are cation-exchangers approved for the treatment of chronic hyperkalemia. Data regarding their efficacy acutely is lacking. Despite this, both drugs are frequently used in the emergent setting. The purpose of this study was to compare the potassium reduction of patiromer to SPS within 6 to 24 hours following a single dose. This retrospective quality improvement project included hyperkalemic patients receiving 1 dose of patiromer or SPS and had a second potassium level drawn in 6 to 24 hours. Doses of 8.4 g of patiromer and 15 g of SPS were considered "low dose" while 16.8 g of patiromer and 30 g of SPS were considered "high dose." The presence of a dose-response relationship was assessed through a linear regression analysis. Mean (SD) potassium reduction was higher in SPS than patiromer [0.76 (0.63) mEq/L vs 0.32 (0.65) mEq/L, ( = .001)]. A dose response relationship was not demonstrated in low versus high dose groups [-0.21 (0.14),  = .13] and CKD, ESRD, and renal transplant patients when compared to patients with normal renal function [0.11 (0.17),  = .51, -0.07 (0.19),  = -0.07 (0.19),  = .73, and -0.10 (0.22),  = .65]. This study suggests a clinically significant reduction in potassium with SPS compared to patiromer. Although SPS was successful in demonstrating this outcome, due to well-documented adverse reactions in the literature and a time to onset of 6 hours, it cannot be recommended for use in acute hyperkalemia either.