Real-world effectiveness of patiromer among hemodialysis patients: a one-year retrospective cohort study

Hyperkalemia is a common and potentially life-threatening complication among patients receiving maintenance hemodialysis (HD). Patiromer (Veltassa ® ) is an oral potassium binder with established potassium control efficacy in chronic kidney disease, but evidence in HD patients remains limited. We conducted a retrospective, single-arm, cohort study of adult patients ( n = 10,860) receiving in-center HD at Fresenius Kidney Care clinics who initiated patiromer between 2016 and 2022, comparing outcomes before (baseline: 3 months prior to initiation) and after initiation (up to 12 months of follow-up). Outcomes included changes in serum potassium (sK), treatment schedules, dosing patterns, and hospitalizations. At baseline, mean age was 60 years, 58% were male, and mean sK was 5.60 ± 0.56 mEq/L. Following patiromer initiation, the proportion of patients achieving sK < 5.5 mEq/L increased from 35.6% to 69.9%. Mean sK decreased to 5.30 mEq/L at quarter 1 (Q1) and remained stable through Q4 (5.21 mEq/L). Mean sK reductions at Q4 were − 0.40, − 0.30, and − 0.21 mEq/L for patiromer doses of 8.4 g, 16.8 g, and 25.2 g once daily, respectively. Patiromer was most commonly prescribed once daily (55.9%) at 8.4 g (91.2%), and dose titrations were infrequent. Use of 1 mEq/L potassium dialysate declined from 17.2% to 11.0%. From baseline to 12 months, all-cause hospitalization rate decreased from 1.77 to 1.68 events per person-year ( p = 0.004), while hyperkalemia-related hospitalizations declined from 0.35 to 0.20 ( p < 0.0001). Serum calcium, sodium, phosphorus, and magnesium remained stable. In this large real-world cohort, lower serum potassium levels were observed following patiromer initiation over 12 months, along with stable electrolyte profiles and a low need for dose adjustments. Reductions in hospitalization rates were also observed over time but should be interpreted cautiously given the single-arm, retrospective design without a control group. These findings support the clinical utility of patiromer for chronic hyperkalemia management in HD patients.