Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Nephrol. Mar 25, 2026; 15(1): 113599
Published online Mar 25, 2026. doi: 10.5527/wjn.v15.i1.113599
Published online Mar 25, 2026. doi: 10.5527/wjn.v15.i1.113599
Long-term patiromer adherence and renin-angiotensin aldosterone system inhibitor utilization: A retrospective study
Nathan Kleinman, Department of Data Analysis and Research, Kleinman Analytic Solutions, LLC., Paso Robles, CA 93446, United States
Tejas Desai, United States Medical and Scientific Affairs - Nephrology/Dialysis, CSL, Char
Charuhas Thakar, Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, United Kingdom
Author contributions: Kleinman N performed the statistical analysis; Kleinman N, Desa T, and Thakar C made substantial contributions to the design of the work, interpretation of data, and the drafting or revision of the manuscript; and have approved this version of the manuscript and have agreed to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated, resolved, and documented.
Institutional review board statement: The need for ethics committee or institutional review board approval were unnecessary, because the dataset used for this study did not meet the definition of “human subjects” in federal requirement 45 CFR 46.102(f). It did not meet the definition of “human subjects” because the data were de-identified, and the investigators had no way to identify the subjects. Thus, all experiments were performed in accordance with relevant guidelines.
Informed consent statement: The need for informed consent to participate were unnecessary, because the dataset used for this study did not meet the definition of “human subjects” in federal requirement 45 CFR 46.102(f). It did not meet the definition of “human subjects” because the data were de-identified, and the investigators had no way to identify the subjects. Thus, all experiments were performed in accordance with relevant guidelines.
Conflict-of-interest statement: Kleinman N reports personal fees from CSL Vifor, during the conduct of the study; personal fees from SeaStar Medical, outside the submitted work.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The prescription claims data used to support the findings in this study are available in the Symphony Health Dataverse (https://www.iconplc.com/solutions/symphony-health/integrated-dataverse-and-source-solutions). Restrictions apply to the availability of these data, which were used under license for this study. Access to the data was provided by CSL Vifor for this study.
Corresponding author: Nathan Kleinman, PhD, Department of Data Analysis and Research, Kleinman Analytic Solutions, LLC., 405 Cool Valley Dr., Paso Robles, CA 93446, United States. nathan@kleinmansolutions.com
Received: August 29, 2025
Revised: October 27, 2025
Accepted: January 7, 2026
Published online: March 25, 2026
Processing time: 197 Days and 11 Hours
Revised: October 27, 2025
Accepted: January 7, 2026
Published online: March 25, 2026
Processing time: 197 Days and 11 Hours
Core Tip
Core Tip: Increased use and optimal dosing of guideline-recommended renin-angiotensin aldosterone system inhibitors (RAASi) improve patient outcomes in patients with heart failure, chronic kidney disease, and diabetes. However, RAASi use is also associated with increased occurrence of high potassium levels (hyperkalemia). Patiromer is indicated for the treatment of hyperkalemia, and patients taking patiromer are better able to tolerate optimal doses of RAASi than patients not taking patiromer. In this United States study from 2014 to 2019, 3323 patients who were more adherent with patiromer proportion of days covered > 80% used more RAASi than 10124 patients who were less adherent with patiromer (proportion of days covered ≤ 80%).