Summary

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• This summary is based on the review of six systematic review(s)/meta-analysis(es). ^[1-6]
• Reduction of Serum Potassium in chronic kidney disease (CKD) and Heart Failure: Patiromer effectively reduced serum potassium, with a mean decrease of -0.84 ± 0.03 mEq/L in severe/end-stage CKD patients and -0.60 ± 0.04 mEq/L in mild/moderate CKD. It lowered hyperkalemia risk in heart failure by 44% (relative risk (RR) 0.56, 95% confidence interval (CI) 0.36-0.87) and achieved normokalemia levels in clinical assessments (surface under the cumulative ranking area (SUCRA) >0.58).
• Support for Renin-Angiotensin-Aldosterone System Inhibitors (RAASi) Therapy Optimization in Heart Failure: Patiromer and other new potassium binders (NPBs) were associated with a higher rate of reaching mineralocorticoid receptor antagonists (MRA) target doses (RR 1.13, 95% CI 1.02-1.25) and a reduction in RAASi discontinuations due to hyperkalemia (RR 0.49, 95% CI 0.25-0.98), supporting sustained RAASi therapy in heart failure management.
• Comparative Efficacy with Other Potassium Binders: Sodium zirconium cyclosilicate (SZC) demonstrated superior efficacy over patiromer in achieving normokalemia (SUCRA >0.78 vs. >0.58 for patiromer), while calcium polystyrene sulfonate showed limited effect compared to sodium polystyrene sulfonate on serum potassium (mean difference (MD) 0.38 mEq/L, 95% CI -0.03 to 0.79).
• Increased Hypokalemia Risk with Patiromer and Other NPBs: Patiromer was associated with an elevated risk of hypokalemia, with a relative risk of 1.51 (95% CI 1.07-2.12), and NPBs overall showed an increased hypokalemia incidence (RR 1.57, 95% CI 1.12-2.21; P = 0.009).
• Adverse Events in CKD Subgroups: In severe/end-stage CKD, adverse events related to patiromer occurred in 16% of patients, leading to a 6% discontinuation rate, while in mild/moderate CKD, related AEs occurred in 12%, with a 2% discontinuation rate. Common AEs included mild-to-moderate constipation (8% in severe, 3% in mild CKD) and diarrhea (4% in severe, 2% in mild CKD).
• Patients included in the studies were adults with CKD, specifically nondialysis CKD stratified by severity (severe/end-stage and mild/moderate CKD), and individuals with heart failure receiving guideline-directed medical therapy (GDMT), often using RAASi or MRAs. Patiromer was effective in reducing serum potassium across CKD stages and supported RAASi optimization in heart failure management.