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Treatment of infant formula with patiromer dose dependently decreases potassium concentration



Hyperkalemia is a potentially life-threatening complication of chronic kidney disease (CKD). Dietary potassium restriction is challenging in infants despite low-potassium formulas. Decreasing potassium in formula using patiromer, a new calcium-based cation exchange polymer may be one option to accomplish this; however, data confirming efficacy is lacking.


Varying doses of patiromer were added to prepared Similac Advance and Similac PM 60/40. Measurements of potassium, calcium, sodium, magnesium, and phosphorus were obtained at baseline and at 30 min, 60 min, and 24 h following patiromer administration.


Following pre-treatment with patiromer, the potassium concentration of both formulas decreased. This effect was mild with the lowest dose but increased in a dose-dependent fashion. Treating for 60 min or 24 h did not yield substantially greater effects than treating for 30 min. Calcium levels increased in both formula groups, mostly in a dose-dependent fashion. Changes in magnesium, sodium, and phosphorus were also seen after patiromer pre-treatment.


Pre-treatment with patiromer decreases the potassium concentration of infant formula. Calcium levels increased after treatment as expected with the majority of ion exchange occurring in 30 min. Treatment of formula with patiromer shows promise as a unique option for managing hyperkalemia.

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This study was funded in full by the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health.

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Correspondence to Neil J. Paloian.

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Paloian, N.J., Bowman, B. & Bartosh, S.M. Treatment of infant formula with patiromer dose dependently decreases potassium concentration. Pediatr Nephrol 34, 1395–1401 (2019).

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  • Patiromer
  • Potassium
  • Hyperkalemia
  • Formula