Treating Acute Hyperkalemia in the Hospital Setting

Patients admitted to inpatient hospital care commonly present with hyperkalemia. According to Abdullah Bin Huda, MMBA, MRCP, and colleagues in the United Kingdom, there are few data available supporting commonly utilized treatment strategies for that patients hospitalized with acute hyperkalemia.

The National Institute for Health and Care Excellence (NICE) has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalemia, there are few data on their use in acute hyperkalemia in the hospital setting, particularly when compared with the current standard of care, calcium polystyrene (CPS).

The researchers conducted a retrospective review of the electronic patient record system at the University Hospitals of Leicester NHS Trust over a 6-month period to examine the efficacy and cost effectiveness of treatments. Results were reported online in the Journal of Clinical Pharmacy and Therapeutics [doi.org/10.1111/jcpt.13766].

The review identified 138 patients who were treated with either SCZ (n=65) or CPS (n=73) to manage hyperkalemia. Simple descriptive statistics were used to analyze results. A naïve cost comparison between the two agents was made based on the analysis results.

CPS was used to treat patients with potassium level 6.07 mmol/L and SZC was used to treat patients with potassium 6.03 mmol/L. The principle causes of hyperkalemia were acute kidney injury, medication, and chronic kidney disease.

Reduction of plasm potassium concentrations in patients with hyperkalemia was effective with both CPS and SZC: CPS reduced potassium concentration by 1.17 mmol/L and SCZ reduced potassium concentration by 1.24 mmol/L. Time to work was similar in the two agents (2.97 days vs 3 days, respectively).

Cost comparison analyses that accounted for raw product price and time needed to dispense the medication revealed that CPS was slightly more cost-effective compared with SZC; although CPS was associated with the cost of increased staff input.

In summary, the authors said, “Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale noncomparative studies.”