Efficacy of Patiromer in Management of Long-Weekend Hyperkalemia in Patients on Intermittent Hemodialysis: A Tertiary Centre Experience from Saudi Arabia

Background: Hyperkalemia is a known complication that is associated with cardiovascular arhythmias and all cause mortality. This complication is frequently encountered in patients with ESKD including those on Intermittent Hemodailysis (IHD) 3 times per week. It is frequently encountered pre dialysis on saturday and sunday in patients on intermittent hemodailysis and is associated with higher incidence of sudden cardiac death specifically after a long weekend without hemodialysis.In our study we tried to identify the incidence of pre dialysis hyperkalemia and efficacy of Patiromer in its management. Methods: This prospective study was done in Renal dialysis unit of King Faisal Specialist Hospital and Research Centre Jeddah (KFSHRCJ) between 01 January 2024 to 31 March 2024. We screened 161 adult patients on Intermittent hemodailysis by extracting labs pre dialysis after the long weekend i.e. on saturday and sunday. We defined hyperkalemia as serum K more than 5.3 mmol/L. Patiromer was prescribed to patients with serum K more than 5.3 mmol/l over the long weekend and repeat K samples were taken pre dialysis on week 1,2,4,8,12 on saturday and sunday. The changes in serum K levels were recorded as average and percentage and studied according to clinical and demographic characteristics of the patients. Results: Out of 161 patients, 58 were found to be having pre dialysis hyperkalemia out of who 36 had serum K between 5.3 to 5.9mmol/l; 11 had serum K between 6 to 6.5 mmol/L and 5 had serum K more than 6.5 mmol/L. Patients with age less than 40 years ( n=29 ) had hyperkalemia more than patients above 40 years (n=23) . Patiromer was intiated for these patients with a mean reduction of serum K by 0.8-2.6 mmol/l with averge reduction of 1.5 mmol/L and this reduction was persistently observed at a followup at 2,4,8 and 12 weeks. 3 patients dropped out due to lack of compliance, 2 dropped out due to hospitalization and 1 patient refused to continue followup for 12 weeks Conclusion: Patiormer is an effective tool in the treatment of Predialysis hyeprkalemia and has sustained effect. It can be used with an acceptable tolerance and efficacy specifically during the long weekend in patients on intermittent hemodialysis