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The pharmacological management of hyperkalemia traditionally considered calcium or sodium polystyrene sulfonate (SPS) and, since recently, the novel binders patiromer and sodium zirconium cyclosilicate (SZC). We evaluated their patterns of use, duration of treatment and relative effectiveness/safety in Swedish routine care.
Observational study of adults initiating therapy with SPS or a novel binder (SZC or patiromer) in Stockholm 2019-2021. We quantified treatment duration by repeated dispensations, compared mean achieved potassium concentration within 60 days, and potential adverse events between treatments.
Total 1879 adults started treatment with SPS, and 147 with novel binders (n=41 patiromer and n=106 SZC). The potassium at baseline for all treatments was 5.7 mmol/L. SPS patients stayed a mean of 61 days on treatment (14% filled ³3 consecutive prescriptions) compared with 109 days on treatment (49% filled ³3 prescriptions) for novel binders. After 15 days of treatment, potassium similarly decreased to 4.6 (SD 0.6) and 4.8 (SD 0.6) mmol/L in SPS and novel binder groups, respectively, and was maintained over the 60 days post-treatment. In multivariable regression, the odds ratio for novel binders (vs SPS) in reaching potassium ≤5.0 mmol/L after 15 days was 0.65 (95% CI 0.38-1.10) and after 60 days 0.89 (95% CI 0.45-1.76). Hypocalcemia, hypokalemia, and initiation of anti-diarrheal/constipation medications were the most-commonly detected adverse events. In multivariable analyses, the OR for these events did not differ between groups.
We observed similar short-term effectiveness and safety for all potassium binders. However, treatment durations were longer for novel binders than for SPS