Dr Samuel Rigby1,2,5, Ms Vivien Chow2,3, Professor David Mudge1,2,4
1Redland Hospital Department of Medicine, Metro South Health,, Redlands , Australia, 2Bayside Kidney Services, Metro South Health,, Redlands, Australia, 3Redland Hospital Pharmacy Department, Metro South Health, Redlands, Australia, 4PAH-Southside Clinical Unit, Faculty of Medicine, the University of Queensland , , Australia, 5Gold Coast Hospital and Health Service, Gold Coast, Australia
Biography:
Bio to come
Abstract:
Background:
Haemodialysis units in Australia and the Pacific are increasingly affected by extreme weather events. Disaster packs containing sodium polystyrene sulfonate (SPS) for prevention of hyperkalaemia are commonly utilised when patients cannot attend dialysis.
Patiromer offers an alternative to SPS, and its use is becoming standard practice in Queensland Health haemodialysis units.
Aim:
To assess the possible benefit of replacing SPS with patiromer in haemodialysis disaster packs.
Method:
We conducted a literature review on the use of Patiromer and SPS in end stage kidney disease and the List of Approved Medicines submissions for patiromer in Queensland. A cost-benefit analysis for our own health service was conducted.
Results:
Obtaining pre-packed SPS from Central Pharmacy would cost $20.65 per patient, followed by current practice at $22.32. Switching to a single or double sachet of patiromer would increase costs to $22.82 or $33.68 respectively, with anticipated further cost related to storage requirements.
Conclusion:
There exists a paucity of high-quality evidence for the efficacy of Patiromer and SPS in the treatment of hyperkalaemia in haemodialysis. Patiromer’s risk profile for chronic use appears more acceptable, however, severe adverse events associated with SPS are rare, and their relevance to single use packs is unclear.
We conclude that the improved tolerability and potential reduction in adverse events does not currently justify the increased cost of patiromer. However, accessing pre-packed SPS from Central Pharmacy would allow for cost saving and reduce handling risks for pharmacy staff. We expect this finding to be applicable to the broader Queensland context.