Comparison of Three Potassium Binders in Patients With Acute Hyperkalemia

BACKGROUND: Hyperkalemia is a common electrolyte abnormality that can occur in hospitalized patients, particularly those with chronic kidney disease. If not appropriately treated, hyperkalemia can result in life-threatening arrhythmias. While sodium polystyrene sulfonate (SPS), patiromer, and sodium zirconium cyclosilicate (SZC) are widely used potassium binders, no study has compared all three binders in lowering potassium in acute hyperkalemia in the acute care setting. OBJECTIVE: The primary outcome was the post-treatment change in serum potassium concentration, compared by binder, within 24 hours. METHODS: This retrospective cohort quality improvement project included 75 adult inpatients who received SPS, SZC, or patiromer at a community teaching hospital between 2021 and 2023. RESULTS: All three potassium binders showed a statistically significant difference in lowering potassium concentrations within 24 hours (p<0.001). Controlling for baseline potassium, standard of care, and BMI, SPS and SZC were superior to patiromer (p=0.001 and p=0.022, respectively). There was no statistically significant difference between SPS and SZC (p=0.206). CONCLUSION: SPS and SZC were superior to patiromer in lowering serum potassium levels in patients with acute hyperkalemia, with no significant difference between SPS and SZC. Considering the established safety concerns associated with SPS, SZC may be the preferred binder for managing acute hyperkalemia in the inpatient setting.