Effect of Patiromer on Urinary Ion Excretion in Healthy

Background and objectives Patiromer is a nonabsorbed potassium-binding polymer that uses calcium as the counterexchange ion. The calcium released with potassium binding has the potential to be absorbed or bind phosphate. Because binding isnot specificfor potassium, patiromer canbind other cations. Here, weevaluatethe effect of patiromer on urine ion excretion in healthy adults, which reflects gastrointestinal ion absorption. Design, setting, participants, & measurements We analyzed the effect of patiromer on urine potassium, sodium, magnesium, calcium, and phosphate in two studies. Healthy adults on controlled diets in a clinical research unit were given patiromer up to 50.4 g/d divided three times a day for 8 days (dose-finding study) or 25.2 g/d in a crossover design as daily or divided (two or three times a day) doses for 18 days (dosing regimen study). On the basis of 24-hour collections, urinary ion excretion during the baseline period (days 5–11) was compared with that during the treatment period (days 13–19; dose-finding study), and the last 4 days of each period were compared across regimens (dosing regimen study). Results In the dose-finding study, patiromer induced a dose-dependent decrease in urine potassium, urine magnesium, and urine sodium (P,0.01 for each). Patiromer at 25.2 g/d decreased urine potassium (mean6SD) by 11406316 mg/d, urine magnesium by 4561 mg/d, and urine sodium by 2256145 mg/d. Urine calcium increased in a dose-dependent manner, and urine phosphate decreased in parallel (both P,0.01). Patiromer at 25.2 g/d increased urine calcium by 73623 mg/d and decreased urine phosphate by 64640 mg/d. Urine potassium, urine sodium, and urine magnesium were unaffected by dosing regimen, whereas the increase in urine calcium was significantly lower with daily compared with three times a day dosing (P=0.01). Urine phosphate also decreased less with daily compared with two or three times a day dosing (P,0.05). Conclusions In healthy adults, patiromer reduces urine potassium, urine sodium, urine magnesium, and urine phosphate, while modestly increasing urine calcium. Compared with divided dosing, administration of patiromer once daily provides equivalent reductions in urine potassium, urine sodium, and urine magnesium, with less effect on urine calcium and urine phosphate. Clin J Am Soc Nephrol 11: 1769–1776, 2016. doi: 10.2215/CJN.01170216