Patiromer Efficacy to Reduce Episodic Hyperkalemia in End Stage Renal Disease Patients

Duke University36 enrolled

Overview

The purpose of this study is to determine whether once-daily dosing of patiromer will reduce the frequency of hyperkalemic episodes in ESRD (end stage renal disease) study participants who receive conventional hemodialysis (HD). The study objective is to determine if patiromer administered orally once a day with breakfast or lunch will reduce episodes of hyperkalemia in ESRD study participants who receive thrice-weekly HD.

This is a prospective, randomized, open-label trial. Eligible ESRD patients who are on thrice weekly HD schedule will be screened from retrospective review of clinical and laboratory parameters from our clinical practice group. A total of 40 study participants (randomized 1:1 study drug: usual care) will be enrolled. Duration of study medication exposure will be 4 weeks. The total duration of study, from enrollment until the end of the washout period will be 7 weeks. This is a proof of concept study, to determine whether administration of patiromer has the potential to change the risk category for ESRD patients who are on conventional HD schedules. In addition, the study will develop and pilot study procedures that could be implemented in a large-scale clinical trial. By nature of the limited size of the study, the power of the trial will be limited. Reducing serum potassium with the use of low dialysate potassium is actually associated with an increased risk of sudden cardiac death. Furthermore, HD patients already carry a high pill burden, and it is unclear if prescription of an additional oral medication will reduce the frequency of episodic hyperkalemia.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

Conditions

Hyperkalemia End Stage Renal Disease

Interventions

Patiromer Oral Powder ProductDRUG

Patients randomized to the patiromer arm will initiate on 8.4 g/day (one pack) given once a day with breakfast or lunch (in place of the full dose of phosphate binder), to start at the end of Week 0. The patiromer dose will be titrated based on serum potassium concentrations drawn on HD1 of Weeks 1, 2, and 3. Patiromer will be increased by 8.4 g/day if K ≥ 5.1 meq/L, decreased by 8.4 g/day if K \< 4.0 mEq/L, and patiromer will be discontinued if K \< 3.5 mEq/L. Patients randomized to the usual care arm will undergo monitoring with laboratory measurements as outlined in the study protocol

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Males and Females, age at least 18 years * ESRD treated with thrice-weekly HD for ≥ 6 months. * At least two measured pre-dialysis serum \[K\] ≥ 5.5 mEq/L or one \[K\] ≥ 6.0 mEq/L noted over the past three months * Current use of dialysate with potassium concentration ≤ 2 mEq/L * Typical consumption of at least two meals per day * Have received customary dietary instruction over prior month * Considered by the treating physician(s) to be in otherwise stable clinical condition. * If patient is of childbearing potential, he/she will be willing to avoid pregnancy during the study using an acceptable birth control method. Exclusion Criteria: * Not considered by the treating physician(s) to be adherent with recommended dialysis schedule and prescribed medications * Life expectancy \< 3 months * Dialysis-dependent for less than 6 months * Non-elective hospitalization in prior 3 months * Currently prescription of oral potassium supplements * In the prior 3 months, therapy with oral potassium-lowering medication * Underlying severe gastrointestinal disorders, including history of ischemic bowel. * Corrected serum calcium concentration \> 10.5 mg/dL in prior three months * Anticipated kidney transplant within the next 3 months * Prisoners or others who are involuntarily incarcerated or detained * Pregnant, breastfeeding, or considering pregnancy. * Participation in a clinical trial of an experimental treatment within the past 30 days

Locations (1)

DaVita Dialysis Sites

Durham, North Carolina, United States

Outcomes

Primary Outcomes

Total Number of Episodes of Serum Potassium ≥ 5.5 mEq/L

To determine if patiromer administered orally once a day with the mid-day meal will reduce episodes of hyperkalemia in ESRD patients who receive thrice-weekly HemoDiaylsis.

Time frame: Week 4

Secondary Outcomes

Number of Episodes of Serum Potassium ≥ 5.5 mEq/L Per Participant

To determine if patiromer administered orally once a day with the mid-day meal will reduce episodes of hyperkalemia in ESRD patients who receive thrice-weekly HemoDiaylsis.

Time frame: 4 weeks

Median Daily Dose of Patiromer That Was Given in Treatment Arm

Time frame: Week 3

Number of Additional Hemodialysis Treatments Due to Hyperkalemia

To determine the between-group differences in need for additional hemodialysis treatments due to hyperkalemia

Time frame: 4 weeks

Number of Participants With Significant Arrhythmia Events as Detected With Cardiac Monitors at Baseline

Clinically significant cardiac arrhythmias included sustained ventricular tachycardia (VT), ventricular fibrillation, asystolic cardiac arrest, non-sustained VT (≥ 3 beats but \< 30 seconds), \> 3 second pause), atrial fibrillation (\> 30 seconds), premature ventricular contractions \> 500/24h or bradycardia (heart rate \< 40 for 5 consecutive beats).

Time frame: Baseline

Number of Participants With Significant Arrhythmia Events as Detected With Cardiac Monitors at Week 4

Data from ClinicalTrials.gov

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