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Patiromer lowers potassium in patients with hyperkalemia taking RAAS inhibitors
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BOSTON — Patiromer reduced serum potassium in patients with hyperkalemia and diabetic kidney disease treated with renin-angiotensin-aldosterone system inhibitors to lower BP, according to a poster presented at the Cardiometabolic Health Conference.
Murray Epstein, MD, professor in the division of nephrology and hypertension at University of Miami Leonard M. Miller School of Medicine, and colleagues analyzed data from 79 patients (51% men; mean age, 67 years) with chronic kidney disease, type 2 diabetes, mild or moderate hyperkalemia and resistant hypertension from the AMETHYST-DN trial. In this trial, patients were assigned varying doses of patiromer (Veltassa, Relypsa) based on the severity of hyperkalemia.
Patients were on RAAS inhibitors and had a systolic BP less than 140 mm Hg at baseline, in addition to four or more antihypertensive medications including a diuretic.
More than half of patients with resistant hypertension (63.3%) completed the study. Discontinuations were associated with adverse events (5.1%), withdrawal of consent (15.2%) and low serum potassium (5.1%); only 1.3% of patients discontinued because of hyperkalemia.
At day 3, mean serum potassium significantly decreased in patients with resistant hypertension and mild or moderate hyperkalemia (P < .001). A mean serum potassium level between 3.8 mEq/L and 5 mEq/L was attained at 3 days for patients with mild hyperkalemia and at 1 week for those with moderate hyperkalemia. These levels were maintained through week 52. Mean serum potassium increased after patiromer was discontinued.
Serious adverse events were seen in 20.3% of patients, though none were related to patiromer, according to the poster.
Mean serum magnesium and calcium levels were within normal range throughout follow-up.
From baseline to day 3, mean systolic BP decreased by 10.9 mm Hg and diastolic BP was reduced by 5.6 mm Hg. Declines in systolic and diastolic BP were 18.4 mm Hg and 10.1 mmHg, respectively, from baseline to week 52.
“A strategy focused on aggressive treatment of [hyperkalemia] may be an important component to the management of [resistant hypertension] in patients with [diabetic kidney disease],” Epstein and colleagues wrote. – by Darlene Dobkowski
Reference:
Epstein M, et al. Patiromer for Hyperkalemia Treatment in Resistant Hypertensive Patients on RAASi with Diabetic Kidney Disease. Presented at: Cardiometabolic Health Conference; Oct. 4-7, 2017; Boston.
Disclosure: The study was supported by Relypsa. Epstein reports he consults for Bayer, OPKO Health and Relypsa.