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A Rare Case of Patiromer Induced Hypercalcemia

Patiromer is a calcium (Ca)-potassium (K) exchange resin approved for the treatment of hyperkalemia. Disorders of Ca or acid base balance were not reported in pre-approval clinical trials. We present a case of a patient with chronic kidney disease (CKD) with an unusual picture of hypercalcemia, meta...

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Autores principales: Kanduri, Swetha Rani, Suchow, Kathryn J., Velez, Juan Carlos Q.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396952/
https://www.ncbi.nlm.nih.gov/pubmed/34442051
http://dx.doi.org/10.3390/jcm10163756
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author Kanduri, Swetha Rani
Suchow, Kathryn J.
Velez, Juan Carlos Q.
author_facet Kanduri, Swetha Rani
Suchow, Kathryn J.
Velez, Juan Carlos Q.
author_sort Kanduri, Swetha Rani
collection PubMed
description Patiromer is a calcium (Ca)-potassium (K) exchange resin approved for the treatment of hyperkalemia. Disorders of Ca or acid base balance were not reported in pre-approval clinical trials. We present a case of a patient with chronic kidney disease (CKD) with an unusual picture of hypercalcemia, metabolic alkalosis and hypokalemia upon intensification of patiromer dosing. A 56-year-old white man with CKD stage 4 (baseline creatinine 2.8 mg/dL) due to type 1 diabetes mellitus, proteinuria (1.5 g/g) and persistently high serum potassium 5.9 mEq/L attributed to type 4 renal tubular acidosis was evaluated in clinic. Due to high risk of CKD progression, patiromer 8.4 g daily, followed by 16.8 g daily was prescribed to enable renin angiotensin aldosterone system (RAAS) inhibitor. After 5 months of being on patiromer 16.8 g daily, routine laboratory tests revealed serum potassium 2.5 mEq/L, serum calcium 12.8 mg/dL and carbon dioxide 34 mEq/L. Patiromer was discontinued and thorough investigation held was negative for other causes of hypercalcemia. Five days after patiromer discontinuation, serum calcium returned to normal. The role of secondary hyperparathyroidism in this case remains unclear. We, therefore recommend cautious vigilance of patients receiving patiromer and undergoing dose escalation.
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spelling pubmed-83969522021-08-28 A Rare Case of Patiromer Induced Hypercalcemia Kanduri, Swetha Rani Suchow, Kathryn J. Velez, Juan Carlos Q. J Clin Med Case Report Patiromer is a calcium (Ca)-potassium (K) exchange resin approved for the treatment of hyperkalemia. Disorders of Ca or acid base balance were not reported in pre-approval clinical trials. We present a case of a patient with chronic kidney disease (CKD) with an unusual picture of hypercalcemia, metabolic alkalosis and hypokalemia upon intensification of patiromer dosing. A 56-year-old white man with CKD stage 4 (baseline creatinine 2.8 mg/dL) due to type 1 diabetes mellitus, proteinuria (1.5 g/g) and persistently high serum potassium 5.9 mEq/L attributed to type 4 renal tubular acidosis was evaluated in clinic. Due to high risk of CKD progression, patiromer 8.4 g daily, followed by 16.8 g daily was prescribed to enable renin angiotensin aldosterone system (RAAS) inhibitor. After 5 months of being on patiromer 16.8 g daily, routine laboratory tests revealed serum potassium 2.5 mEq/L, serum calcium 12.8 mg/dL and carbon dioxide 34 mEq/L. Patiromer was discontinued and thorough investigation held was negative for other causes of hypercalcemia. Five days after patiromer discontinuation, serum calcium returned to normal. The role of secondary hyperparathyroidism in this case remains unclear. We, therefore recommend cautious vigilance of patients receiving patiromer and undergoing dose escalation. MDPI 2021-08-23 /pmc/articles/PMC8396952/ /pubmed/34442051 http://dx.doi.org/10.3390/jcm10163756 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Kanduri, Swetha Rani
Suchow, Kathryn J.
Velez, Juan Carlos Q.
A Rare Case of Patiromer Induced Hypercalcemia
title A Rare Case of Patiromer Induced Hypercalcemia
title_full A Rare Case of Patiromer Induced Hypercalcemia
title_fullStr A Rare Case of Patiromer Induced Hypercalcemia
title_full_unstemmed A Rare Case of Patiromer Induced Hypercalcemia
title_short A Rare Case of Patiromer Induced Hypercalcemia
title_sort rare case of patiromer induced hypercalcemia
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396952/
https://www.ncbi.nlm.nih.gov/pubmed/34442051
http://dx.doi.org/10.3390/jcm10163756
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