From the Guidelines
Outpatient management of hyperkalemia should prioritize the use of patiromer (Veltassa) as a first-line treatment option for patients with mild to moderate hyperkalemia, due to its effectiveness in maintaining normokalemia and reducing the risk of hyperkalemia-related complications, as demonstrated in recent clinical studies 1.
Treatment Options
The management of hyperkalemia in the outpatient setting involves several treatment options, including:
- Dietary potassium restriction to less than 2-3 g/day
- Medication adjustments, such as discontinuation or dose reduction of potassium-sparing diuretics, ACE inhibitors, ARBs, and NSAIDs
- Loop diuretics like furosemide 20-40 mg once or twice daily to enhance potassium excretion in patients with adequate kidney function
- Oral potassium binders, such as sodium polystyrene sulfonate (Kayexalate) and newer agents like patiromer (Veltassa) and sodium zirconium cyclosilicate (Lokelma)
Patiromer as a First-Line Treatment Option
Patiromer has been shown to be effective in maintaining normokalemia in patients with advanced CKD and resistant hypertension, as well as in patients with diabetes and CKD, including those with heart failure receiving RAAS inhibitors 1. The use of patiromer has also been associated with a reduced risk of hyperkalemia-related complications, such as cardiac arrhythmias and muscle weakness.
Monitoring and Education
Regular monitoring of serum potassium levels is essential, initially every 1-3 days until stable, then weekly to monthly depending on severity. Patients should be educated about high-potassium foods to avoid and symptoms of worsening hyperkalemia that warrant immediate medical attention, such as muscle weakness, palpitations, or numbness and tingling.
Key Considerations
When using patiromer, it is essential to separate its administration from other oral medications by 3 or more hours to minimize the risk of binding with patiromer. Additionally, patients should be monitored for potential adverse effects, such as gastrointestinal events and electrolyte disturbances, including hypokalemia and hypomagnesemia 1.
The most recent and highest quality study 1 supports the use of patiromer as a first-line treatment option for outpatient management of hyperkalemia, due to its effectiveness and safety profile.
From the FDA Drug Label
Veltassa is indicated for the treatment of hyperkalemia in adults and pediatric patients ages 12 years and older. Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia (1). The treatment options for outpatient management of hyperkalemia include:
- Patiromer (PO): for adults and pediatric patients ages 12 years and older 2
- Polystyrene sulfonate (PO): for the treatment of hyperkalemia 3 Key points:
- Both medications have a delayed onset of action and should not be used as an emergency treatment for life-threatening hyperkalemia.
From the Research
Treatment Options for Outpatient Management of Hyperkalemia
The treatment options for outpatient management of hyperkalemia include:
- Stabilizing the cardiac membrane
- Shifting potassium into cells
- Decreasing total body potassium content 4
- Review of medications potentially responsible for hyperkalemia
- Ensuring effective diuretic therapy
- Correcting metabolic acidosis if present 4
- Using potassium binding drugs and sodium-glucose cotransporter 2 inhibitors to maintain the use of renin-angiotensin-aldosterone inhibitors 4, 5
Pharmacologic Treatment
Pharmacologic treatment options for chronic hyperkalemia include:
- Potassium binders such as patiromer, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate 5, 6
- Loop diuretics to enhance potassium excretion 5
- Sodium-glucose cotransporter 2 inhibitors to reduce potassium levels 4
Management of Hyperkalemia
The management of hyperkalemia can be achieved through:
- Elimination of medications that can raise serum potassium levels 7
- Use of new potassium-binding medications for acute and chronic therapy of hyperkalemia 7
- Standardization of treatment thresholds and guidelines for outpatient hyperkalemia management 8
Challenges in Outpatient Hyperkalemia Management
The challenges in outpatient hyperkalemia management include: