1 Recommendations

1 Recommendations

1.1 Patiromer is recommended as an option for treating hyperkalaemia in adults only if used:

  • in emergency care for acute life-threatening hyperkalaemia alongside standard care or

  • for people with persistent hyperkalaemia and stages 3b to 5 chronic kidney disease or heart failure, if they:

    • have a confirmed serum potassium level of at least 6.0 mmol/litre and

    • are not taking, or are taking a reduced dosage of, a renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and

    • are not on dialysis.

1.2 Stop patiromer if RAAS inhibitors are no longer suitable.

1.3 This recommendation is not intended to affect treatment with patiromer that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Patiromer is a treatment for people with high blood potassium levels (hyperkalaemia). It can be used for adults with chronic kidney disease or heart failure, either:

  • in emergency care alongside standard care for acute life-threatening hyperkalaemia or

  • for persistent hyperkalaemia if they are able to have RAAS inhibitors.

Treating acute life-threatening hyperkalaemia in emergency care is established clinical practice. Other potassium-lowering treatments are rarely used in this setting because they are poorly tolerated. Patiromer could be a useful addition to emergency care.

Clinical trials show that patiromer lowers serum potassium. But there is no clinical evidence that it extends life or improves quality of life. Patiromer may allow people to stay on RAAS inhibitors (drugs used to treat heart failure and kidney disease) for longer or at a higher dose. This may extend life and improve quality of life.

Considering the benefit from more people being able to stay on RAAS inhibitors, the cost-effectiveness estimates for patiromer suggest that it is a reasonable use of NHS resources. Therefore, it is recommended for treating confirmed persistent hyperkalaemia when started in hospital and alongside standard care for treating acute life-threatening hyperkalaemia in emergency care.

  • National Institute for Health and Care Excellence (NICE)