A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department
Pavel Goriacko,1,2 Ladan Golestaneh,3 Katherine E Di Palo3 1Center for Health Data Innovations, Montefiore Einstein, Bronx, NY, USA; 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; 3Department of Medicine, Montefiore Medical Center, Bronx, NY,...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2024-12-01
|
| Series: | Open Access Emergency Medicine |
| Subjects: | |
| Online Access: | https://www.dovepress.com/a-retrospective-study-of-patiromer-as-adjunct-to-insulin-therapy-for-a-peer-reviewed-fulltext-article-OAEM |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850177545861857280 |
|---|---|
| author | Goriacko P Golestaneh L Di Palo KE |
| author_facet | Goriacko P Golestaneh L Di Palo KE |
| author_sort | Goriacko P |
| collection | DOAJ |
| description | Pavel Goriacko,1,2 Ladan Golestaneh,3 Katherine E Di Palo3 1Center for Health Data Innovations, Montefiore Einstein, Bronx, NY, USA; 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; 3Department of Medicine, Montefiore Medical Center, Bronx, NY, USACorrespondence: Pavel Goriacko, Email pgoriack@montefiore.orgObjective: To investigate the clinical utility of administering patiromer as an adjunct to insulin for potassium reduction in patients presenting to the emergency department (ED) with hyperkalemia.Methods: This retrospective cohort study used electronic health record data to identify adults treated with at least one intravenous dose of regular insulin for hyperkalemia within the ED. Patients who were administered patiromer within one hour before or after their insulin dose were categorized as the intervention group. Matching was performed at a 1:1 ratio. The primary outcome, mean change in potassium from baseline to the latest value within the 4– 12 hour interval, was compared. Secondary outcomes included net clinical benefit, defined as the mean difference in the number of potassium-lowering interventions minus the change in potassium.Results: The final analysis included 133 patients treated with patiromer plus insulin and 133 patients treated with insulin alone. Participants had a mean age of 71 years; 43% were female, 31% self-identified as Black, and 38% self-identified as Latinx. No significant changes were observed in potassium from baseline (mean levels 6.2 mEq/L in each group) to the 4– 12 hour time frame (patiromer: − 0.90 mEq/L, n=78 vs insulin-only: − 0.98 mEq/L, n=81; p = 0.51). The calculated net clinical benefit of potassium reduction was − 0.25 in favor of the patiromer plus insulin group; however, this difference did not reach statistical significance. In the subgroup of eGFR > 30 mL/min, patiromer group received numerically less potassium-lowering interventions (0.63 vs 1.12, p = 0.057).Conclusion: In this study of patients with acute hyperkalemia in the ED setting, concurrent administration of patiromer did not result in more sustained potassium reduction compared to insulin alone in the overall cohort. The trend in favor of adjunct patiromer in the subgroup with adequate renal function warrants further investigation.Keywords: patiromer, hyperkalemia, emergency department, insulin, renal impairment |
| format | Article |
| id | doaj-art-ecf07be66e9044cb97462d60717b3593 |
| institution | OA Journals |
| issn | 1179-1500 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Open Access Emergency Medicine |
| spelling | doaj-art-ecf07be66e9044cb97462d60717b35932025-08-20T02:18:57ZengDove Medical PressOpen Access Emergency Medicine1179-15002024-12-01Volume 1630531297986A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency DepartmentGoriacko PGolestaneh LDi Palo KEPavel Goriacko,1,2 Ladan Golestaneh,3 Katherine E Di Palo3 1Center for Health Data Innovations, Montefiore Einstein, Bronx, NY, USA; 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; 3Department of Medicine, Montefiore Medical Center, Bronx, NY, USACorrespondence: Pavel Goriacko, Email pgoriack@montefiore.orgObjective: To investigate the clinical utility of administering patiromer as an adjunct to insulin for potassium reduction in patients presenting to the emergency department (ED) with hyperkalemia.Methods: This retrospective cohort study used electronic health record data to identify adults treated with at least one intravenous dose of regular insulin for hyperkalemia within the ED. Patients who were administered patiromer within one hour before or after their insulin dose were categorized as the intervention group. Matching was performed at a 1:1 ratio. The primary outcome, mean change in potassium from baseline to the latest value within the 4– 12 hour interval, was compared. Secondary outcomes included net clinical benefit, defined as the mean difference in the number of potassium-lowering interventions minus the change in potassium.Results: The final analysis included 133 patients treated with patiromer plus insulin and 133 patients treated with insulin alone. Participants had a mean age of 71 years; 43% were female, 31% self-identified as Black, and 38% self-identified as Latinx. No significant changes were observed in potassium from baseline (mean levels 6.2 mEq/L in each group) to the 4– 12 hour time frame (patiromer: − 0.90 mEq/L, n=78 vs insulin-only: − 0.98 mEq/L, n=81; p = 0.51). The calculated net clinical benefit of potassium reduction was − 0.25 in favor of the patiromer plus insulin group; however, this difference did not reach statistical significance. In the subgroup of eGFR > 30 mL/min, patiromer group received numerically less potassium-lowering interventions (0.63 vs 1.12, p = 0.057).Conclusion: In this study of patients with acute hyperkalemia in the ED setting, concurrent administration of patiromer did not result in more sustained potassium reduction compared to insulin alone in the overall cohort. The trend in favor of adjunct patiromer in the subgroup with adequate renal function warrants further investigation.Keywords: patiromer, hyperkalemia, emergency department, insulin, renal impairmenthttps://www.dovepress.com/a-retrospective-study-of-patiromer-as-adjunct-to-insulin-therapy-for-a-peer-reviewed-fulltext-article-OAEMpatiromerhyperkalemiaemergency departmentinsulinrenal impairment |
| spellingShingle | Goriacko P Golestaneh L Di Palo KE A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department Open Access Emergency Medicine patiromer hyperkalemia emergency department insulin renal impairment |
| title | A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department |
| title_full | A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department |
| title_fullStr | A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department |
| title_full_unstemmed | A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department |
| title_short | A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department |
| title_sort | retrospective study of patiromer as adjunct to insulin therapy for acute hyperkalemia in the emergency department |
| topic | patiromer hyperkalemia emergency department insulin renal impairment |
| url | https://www.dovepress.com/a-retrospective-study-of-patiromer-as-adjunct-to-insulin-therapy-for-a-peer-reviewed-fulltext-article-OAEM |
| work_keys_str_mv | AT goriackop aretrospectivestudyofpatiromerasadjuncttoinsulintherapyforacutehyperkalemiaintheemergencydepartment AT golestanehl aretrospectivestudyofpatiromerasadjuncttoinsulintherapyforacutehyperkalemiaintheemergencydepartment AT dipaloke aretrospectivestudyofpatiromerasadjuncttoinsulintherapyforacutehyperkalemiaintheemergencydepartment AT goriackop retrospectivestudyofpatiromerasadjuncttoinsulintherapyforacutehyperkalemiaintheemergencydepartment AT golestanehl retrospectivestudyofpatiromerasadjuncttoinsulintherapyforacutehyperkalemiaintheemergencydepartment AT dipaloke retrospectivestudyofpatiromerasadjuncttoinsulintherapyforacutehyperkalemiaintheemergencydepartment |