Abstract: TH-PO780

Patient Characteristics and Correlates of Patiromer Initiation for Hyperkalemia in Hemodialysis

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Rowan, Christopher G, COHRDATA, Santa Monica, California, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Oestreicher, Nina, Relypsa Inc., a Vifor Pharma Company, Redwood City, California, United States
  • Rakov, Viatcheslav, Vifor Pharma, St. Gallen, SG, Switzerland
  • Connaire, Jeffrey J., DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Spiegel, David M., Relypsa Inc., a Vifor Pharma Company, Redwood City, California, United States
  • Kovesdy, Csaba P., University of Tennessee, Memphis, Tennessee, United States
Background

Patiromer is a novel potassium-binding polymer for treatment of chronic hyperkalemia. We retrospectively compared U.S. hemodialysis (HD) patients (pts) who initiated patiromer vs sodium polystyrene sulfate (SPS) in typical practice.

Methods

We identified new users of patiromer or SPS between 12/2015-12/2016 from a large U.S. dialysis provider. Baseline characteristics were obtained in the year prior to the 1st patiromer or SPS order. We identified correlates of patiromer vs SPS using multivariable logistic regression.

Results

Pts initiating patiromer vs SPS were less likely to be black, more likely to use a dialysate K+<2 mEq/L; had higher serum K+, and more electrolyte-related hospitalizations (Table). Having ≥3 serum K+ tests ≥5.0 was associated with 5x the odds of initiating patiromer vs SPS (Figure).

Conclusion

Multiple hyperkalemia episodes and a recent SPS order were associated with patiromer initiation. Patiromer may be used predominantly in HD pts with more severe hyperkalemia who failed SPS. Studies are needed to determine the clinical impact of patiromer.

Table. Baseline Characteristics
Baseline CharacteristicsPatiromer
(N=527)
SPS
(N=852)
Baseline CharacteristicsPatiromer
(N=527)
SPS
(N=852)
Age: Mean (SD)59 (14)61 (14)SPS order 91 days b/f index date10.80%5.30%
Female43.1%47.1%Insulin order 1 year b/f index date23.90%30.00%
Race: Black17.1%29.9%K+ mEq/L: Mean (SD)5.8 (0.7)5.4 (1.0)
Primary Payer: Medicare79.5%80.0%# K+ tests ≥5.0 mEq/L: 91 days b/f index date8.4 (4.1)4.8 (4.3)
Dialysis Vintage (years): Mean (SD)5.7 (4)5.4 (4.4)Kt/V: Mean (SD)1.6 (0.3)1.6 (0.3)
# HD treatments 91 days b/f index date37.8 (3.6)37.2 (4.2)nPCR: Mean (SD)1.2 (0.3)1.1 (0.3)
K+ dialysate <2 mEq/L32.3%19.2%Hospitalization: 1 year b/f index date60.30%67.70%
Peripheral Vascular Disease10.2%4.8%Electrolyte Related Hospitalization14.40%8.50%

Figure. BaselineCorrelates of Patiromer Initiation

Funding

  • Commercial Support