Comparison of Patiromer and Sodium Polystyrene Sulfonate for Chronic Hyperkalemia in Patients with Chronic Kidney Disease: A Prospective Cohort Study

Abstract

Chronic hyperkalemia in patients with chronic kidney disease (CKD) often limits the use of vital renin-angiotensin-aldosterone system inhibitors (RAASi). This prospective cohort study compared the efficacy and safety of patiromer (n=40) versus sodium polystyrene sulfonate (SPS) (n=40) for chronic hyperkalemia management in 80 adult CKD patients. Over a six-month follow-up, both agents effectively reduced serum potassium from similar baseline levels (patiromer: 5.73 ± 0.59 mmol/L; SPS: 5.62 ± 0.50 mmol/L) with no significant difference in efficacy (p>0.05). However, key differences in the clinical impact on RAASi therapy emerged, alongside numerical but statistically non-significant differences in tolerability. Patients receiving patiromer had a significantly lower rate of RAASi therapy discontinuation compared to the SPS group (5.2% vs. 36.3%; p=0.033), enabling continuation of guideline-directed medical therapy. A trend towards poorer compliance was noted in the SPS group (22.5% vs. 7.5%; p=0.060). An exploratory analysis revealed that patiromer initiation significantly increased tacrolimus levels in post-kidney transplant recipients (p=0.003), necessitating dose adjustments. While both agents showed comparable potassium-lowering efficacy, patiromer's numerical advantages in tolerability and significant benefit in maintaining RAASi therapy position it as a valuable therapeutic option in this high-risk population.