China
Africa
Explore chapters and articles related to this topic
The Patient with Renal Dysfunction
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Alexandros Briasoulis, Ily Kristine T. Yumul-Non, Paulino Alvarez
Patiromer and sodium zirconium cyclosilicate are novel potassium binders that may help mitigate hyperkalemia with angiotensin blockade and AA specifically in CKD patients. Patiromer (RLY5016) is a non-absorbed, sodium-free polymer that exchanges calcium for potassium in the gastrointestinal (GI) tract, promoting fecal potassium excretion.78 In PEARL-HF (Parallel Evaluation of RLY5016 in Heart Failure), patiromer prevented hyperkalemia in HF patients with CKD who had been on an angiotensin blockade regimen and spironolactone (25–50 mg/day).78 Sodium zirconium cyclosilicate (ZS-9) is a highly selective cation exchanger that entraps potassium in the GI tract, exchanging it for hydrogen and sodium. It can correct hyperkalemia within 48 hours and its effects are noted to be most significant in higher potassium levels at baseline.79 Prior to administration of either of these agents, careful consideration of potential adverse effects is required, such as constipation, hypomagnesemia and drug interactions (metformin, levothyroxine) with patiromer, or edema with ZS-9. Also, a low-potassium diet and loop diuretics should be attempted first before initiation of these agents.
A cost-effectiveness analysis of patiromer for the treatment of hyperkalemia in chronic kidney disease patients with and without heart failure in Spain
Published in Journal of Medical Economics, 2022
José Ramón González-Juanatey, Álvaro González-Franco, Patricia de Sequera, Marta Valls, Antonio Ramirez de Arellano, Elisenda Pomares, Diana Nieves
Over the past decades, ion exchange resins have been the most commonly used treatment to address HK, but they are associated with several drawbacks, such as safety-related contraindications due to serious gastrointestinal adverse events, risk of hypokalaemia, poor tolerability that can lead to low adherence to treatment, etc.5–7. Recent Spanish real-world data reported that only 36.8% of the patients were adherent to the treatment in the first year and 17.5% in the third year7. Patiromer is a sodium-free, cation exchange polymer that is not absorbed and is able to bind free potassium in the lumen of the gastrointestinal tract, thereby reducing its absorption6. In the OPAL-HK study, patiromer demonstrated the reduction of serum potassium levels and prevent the recurrence of HK; and, consequently, patiromer allowed to maintain RAASi optimal doses8. Patiromer has significantly changed the management of CKD by offering a solution for the maintenance of normokalemia in patients treated with RAASi.
Sodium zirconium cyclosilicate for the management of chronic hyperkalemia in kidney disease, a novel agent
Published in Expert Review of Clinical Pharmacology, 2021
Anjay Rastogi, Ramy M. Hanna, Anita Mkrttchyan, Maham Khalid, Sinan Yaqoob, Kelly Shaffer, Puneet Dhawan, Niloofar Nobakht, Mohammad Kamgar, Ray Goshtaseb, Kristine Sarmosyan, Mariarosaria Gnarini, Olivia Wassef, Edgar Lerma
Patiromer calcium is a newer agent that has been evaluated and approved by the US FDA for the treatment of hyperkalemia in 2015. It is a polymer of fluoroacrylate monomers, with multiple potassium-binding sites that binds potassium in the GI tract and removes it from the body [33]. Patiromer has not been assigned a risk rating in pregnancy, but as indicated in the package insert, it is not absorbed into the blood stream. Given this fact, patiromer is not expected to result in fetal risk or be in the breast milk of lactating mothers [33]. The starting dose of patiromer currently recommended is 8.4 grams/day, and a dose response curve has been noted prior with 25.2 grams noted as the maximum dose [34]. The onset of action is slower than SPS at 10 hours, but is sustained for up to 2 days [34].
An evaluation of sodium zirconium cyclosilicate as a treatment option for hyperkalemia
Published in Expert Opinion on Pharmacotherapy, 2021
Chandan Takkar, Tareq Nassar, Wajeh Qunibi
Both SZC and Patiromer were generally well tolerated with no striking differences in the rate of adverse effects (Table 4). In clinical trials, SZC was associated with urinary tract infections and hypokalemia-related QTc-interval prolongation. Moreover, SZC was associated with a dose-related increase in the incidence of edema, particularly in patients treated with the 15 g dose. The rate of gastrointestinal adverse effects such as constipation, diarrhea or nausea with SZC was similar to those observed in placebo and less than those with Patiromer. The most common adverse events associated with Patiromer use were gastrointestinal such as constipation, diarrhea and nausea. Hypomagnesemia, defined as serum magnesium level < 1.8 mg/dl was reported in 6.7% of patients treated with Patiromer but serum levels <1.0 mg/dl was not reported. Also, hypokalemia with serum potassium level < 3.5 mEq/l was reported in 6.9% of patients but potassium levels <3.0 mEq/l was not reported in any trial.