TY - JOUR
T1 - Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM)
T2 - a randomised controlled trial in the emergency department
AU - Rafique, Zubaid
AU - Safdar, Basmah
AU - Duanmu, Youyou
AU - Boone, Stephen
AU - Meltzer, Andrew
AU - Bischof, Jason J.
AU - Robinson, Dave
AU - Budden, Jeffrey
AU - Budd, Jeffrey
AU - Quinn, Carol M.
AU - Milliet, Christian
AU - Singer, Adam J.
AU - Soto, Karina
AU - Peacock, Frank
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
PY - 2026/2
Y1 - 2026/2
N2 - ObjectivesHyperkalaemia (HK) is common in the emergency department (ED) and can cause life-threatening arrhythmias. Patiromer is a potassium binder whose role in acute HK management is uncertain; therefore, we investigated the efficacy and safety of patiromer as an adjunct to the standard of care treatment of HK in the ED.DesignA prospective, randomised, double-blind, placebo-controlled study.Setting16 ED sites across the USA.ParticipantsPatients aged ≥18 years treated at a participating ED who were found to have serum potassium ≥5.8 mEq/L.InterventionsParticipants were randomised 1:1 to standard combination therapy (25 g intravenous dextrose, 5 units intravenous insulin and 10 mg albuterol) with either patiromer or placebo. The initial dose was given within 1 hour of the potassium result, and the second dose 24 hours later.Primary and secondary outcome measuresThe primary endpoint was net clinical benefit (NCB) at 6 hours, defined as the change in number of potassium-lowering interventions minus change in serum potassium. Adverse events (AEs) were also recorded.ResultsThe study was terminated early and did not reach the prespecified sample size. Overall, 111 patients (53 patiromer and 58 placebo) were analysed. Mean (SD) age was 61.34 (15.21) years, 34% were female, 48% white and 22.5% received chronic haemodialysis. Mean baseline potassium was 6.5 mmol/L. NCB at 6 hours was similar between patiromer and placebo (−0.6 vs −0.4; p=0.44). Potassium levels at 2, 4 and 6 hours were similar between the groups (5.50 vs 5.70, 5.45 vs 5.65, 5.50 vs 5.60; patiromer and placebo (all p>0.05)). The number of interventions per patient was similar (p>0.05) between groups at each time point. The proportion of patients experiencing AEs was not significant between the patiromer and placebo groups (16.98% vs 32.76%; p=0.08).ConclusionsNo differences in efficacy were reported in this study, which was underpowered to detect statistical efficacy of patiromer over placebo.Trial registration numberNCT04443608.
AB - ObjectivesHyperkalaemia (HK) is common in the emergency department (ED) and can cause life-threatening arrhythmias. Patiromer is a potassium binder whose role in acute HK management is uncertain; therefore, we investigated the efficacy and safety of patiromer as an adjunct to the standard of care treatment of HK in the ED.DesignA prospective, randomised, double-blind, placebo-controlled study.Setting16 ED sites across the USA.ParticipantsPatients aged ≥18 years treated at a participating ED who were found to have serum potassium ≥5.8 mEq/L.InterventionsParticipants were randomised 1:1 to standard combination therapy (25 g intravenous dextrose, 5 units intravenous insulin and 10 mg albuterol) with either patiromer or placebo. The initial dose was given within 1 hour of the potassium result, and the second dose 24 hours later.Primary and secondary outcome measuresThe primary endpoint was net clinical benefit (NCB) at 6 hours, defined as the change in number of potassium-lowering interventions minus change in serum potassium. Adverse events (AEs) were also recorded.ResultsThe study was terminated early and did not reach the prespecified sample size. Overall, 111 patients (53 patiromer and 58 placebo) were analysed. Mean (SD) age was 61.34 (15.21) years, 34% were female, 48% white and 22.5% received chronic haemodialysis. Mean baseline potassium was 6.5 mmol/L. NCB at 6 hours was similar between patiromer and placebo (−0.6 vs −0.4; p=0.44). Potassium levels at 2, 4 and 6 hours were similar between the groups (5.50 vs 5.70, 5.45 vs 5.65, 5.50 vs 5.60; patiromer and placebo (all p>0.05)). The number of interventions per patient was similar (p>0.05) between groups at each time point. The proportion of patients experiencing AEs was not significant between the patiromer and placebo groups (16.98% vs 32.76%; p=0.08).ConclusionsNo differences in efficacy were reported in this study, which was underpowered to detect statistical efficacy of patiromer over placebo.Trial registration numberNCT04443608.
KW - ACCIDENT & EMERGENCY MEDICINE
KW - CARDIOLOGY
KW - NEPHROLOGY
UR - https://www.scopus.com/pages/publications/105030907783
U2 - 10.1136/bmjopen-2025-105103
DO - 10.1136/bmjopen-2025-105103
M3 - Article
C2 - 41730555
AN - SCOPUS:105030907783
SN - 2044-6055
VL - 16
JO - BMJ Open
JF - BMJ Open
IS - 2
ER -