{"doi":"10.1016/j.ekir.2020.12.026","title":"Gut Microbiota and Host Cometabolism Are Altered by Patiromer-Induced Changes in Serum and Stool Potassium","abstract":"Hyperkalemia is a common and serious electrolyte abnormality in advanced CKD patients.1Bianchi S. Aucella F. De Nicola L. Genovesi S. et al.Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology.J Nephrol. 2019; 32: 499-516Crossref PubMed Scopus (40) Google Scholar Adaptive increase in colonic potassium (K+) excretion in patients with end-stage renal disease (ESRD) partially compensates for the loss of K+ excretion by the kidney.2Panese S. Mártin R.S. Virginillo M. et al.Mechanism of enhanced transcellular potassium-secretion in man with chronic renal failure.Kidney Int. 1987; 31: 1377-1382Abstract Full Text PDF PubMed Scopus (22) Google Scholar Patiromer is a nonabsorbed polymer that binds K+ throughout the gastrointestinal (GI) tract and leads to lowering serum K+ levels.3Weir M.R. Bakris G.L. Bushinsky D.A. et al.Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors.N Engl J Med. 2015; 372: 211-221Crossref PubMed Scopus (429) Google Scholar Interestingly, K+ is essential for the growth, colonization, and virulence of some bacteria.4Price-Whelan A. Poon C.K. Benson M.A. et al.Transcriptional profiling of Staphylococcus aureus during growth in 2 M NaCl leads to clarification of physiological roles for Kdp and Ktr K+ uptake systems.mBio. 2013; 4Crossref PubMed Scopus (52) Google Scholar,5MacLEOD R.A. Snell E.E. The effect of related ions on the potassium requirement of lactic acid bacteria.J Biol Chem. 1948; 176: 39-52Abstract Full Text PDF PubMed Google Scholar Thus, ambient K+ could have a significant effect on gut microbiota and their metabolic function. Previously, we have examined the effect to K+ binder patiromer treatment on serum and stool electrolytes in hemodialysis (HD) patients.6Amdur R.L. Paul R. Barrows E.D. et al.The potassium regulator patiromer affects serum and stool electrolytes in patients receiving hemodialysis.Kidney Int. 2020; 98: 1331-1340Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar To our knowledge, there have been no previous reports regarding the impact of K+ binder–induced changes in intestinal K+ content on the gut microbiota and microbiota-related metabolites in HD patients. In this clinical trial, we investigated the effect of lowering serum K+ by patiromer on the gut microbial community composition, their functional capacity, and host-cometabolism in HD patients.ResultsClinical ParametersThis is an ancillary to a parent study that examined the effect to patiromer treatment on serum and stool electrolytes in HD patients.6Amdur R.L. Paul R. Barrows E.D. et al.The potassium regulator patiromer affects serum and stool electrolytes in patients receiving hemodialysis.Kidney Int. 2020; 98: 1331-1340Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Characteristics of the study participants (20 controls, 21 HD patients) are shown in Table 1. Blood urea nitrogen, creatinine, and K+ were significantly elevated in HD patients. Dialysis prescription was unchanged during the study and dialysate K+ was 2 mEq/l throughout the study period. The dietary intake estimated by food frequency questionnaire showed that there was no significant change in the dietary intake of K+, protein, carbohydrate, or fat intake during the study phases (Table S1). Patiromer treatment resulted in a significant decrease in serum K+, which was accompanied increase in stool K+ (Figure 1b and 1c , Tables S2 and S3). Circulating level of soluble CD14 (Scd14) was lower in control subjects without kidney disease compared to HD patients. None of the inflammatory markers were altered by patiromer treatment (Table S4). The information about dialysis and medication was summarized in Table S5.Table 1Subject characteristics at baselinePatient variableControl (n = 20)ESRD/dialysis (n = 21)P valueSex female, n (%)11 (55)14 (52)0.99Age60 ± 1057 ± 110.22Race, n (%)0.12 Asian3 (15)0 (0) Black11 (55)20 (74) Caucasian5 ","journal":"Kidney International Reports","year":2020,"id":108864,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9576,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":520752,"name":"Elliot S. Friedman","orcid":"0000-0003-0050-4965","position":1,"is_corresponding":false},{"id":520753,"name":"Renu Regunathan-Shenk","orcid":"0000-0003-4407-9067","position":2,"is_corresponding":false},{"id":521423,"name":"Anvesha Shrivastava","orcid":null,"position":3,"is_corresponding":false},{"id":521424,"name":"Ian R. Barrows","orcid":null,"position":4,"is_corresponding":false},{"id":372455,"name":"Richard Amdur","orcid":"0000-0002-4900-653X","position":5,"is_corresponding":false},{"id":521425,"name":"Sarah C. Andrews","orcid":null,"position":6,"is_corresponding":false},{"id":521426,"name":"Elizabeth Barrows","orcid":null,"position":7,"is_corresponding":false},{"id":292967,"name":"Dominic S. Raj","orcid":"0000-0001-9647-083X","position":8,"is_corresponding":false},{"id":245698,"name":"Bei Gao","orcid":"0000-0002-3321-2339","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:12:46.854423Z","pmid":"33732997","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}