Patiromer- a new oral potassium binder

by Dr. Lazowski

Majority of ingested potassium is absorbed and excreted in the urine. Potassium excretion is impaired by a marked reduction in the kidney function that leads to elevation of serum potassium level. Hyperkalemia (increased potassium level) can also be caused by medications like angiotensin converting enzyme inhibitors and angiotensin receptor blockers that are commonly used to slow the progression of renal disease. Elevated potassium level can be harmful and can cause irregular heart beat and in extreme cases death.  Until recently sodium polystyrene sulfonate (Kayexelate) has been used to treat hyperkalemia. It binds potassium in the gut and enhances potassium excretion in the stool frequently causing diarrhea. Recently Patiromer (Veltassa) has been approved for the treatment of high potassium level. It is a safe, oral, non-absorbable potassium binding agent that is used daily and can effectively lower potassium level. It has three available dosing however treatment is usually started with the lowest dose. Since Patiromer can bind other oral medications it is suggested that they should be administered 6 hours before or after it has been used. This new therapy is promising since hyperkalemia has been a major problem in patients with a renal disease. Daily use of Patiromer could allow clinicians to safely use ACE inhibitors and ARB to protect renal function without causing dangerous high potassium elevation. Clin J Am Soc Nephrol11: 1769-1776, 2016