Study shows patiromer reduces potassium levels, lowers risk of heart failure drugs in CKD
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BOSTON — Trial results show patiromer is effective in controlling hyperkalemia and helps to reduce the risk of using blood pressure medications in patients with chronic kidney disease and heart failure.
“Renin-angiotensin-aldosterone system inhibitors (RAASi) are the cornerstone of treatment for both heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease,” Matthew R. Weir, MD, of the University of Maryland, and colleagues wrote in a late-breaking abstract presented at the National Kidney Foundation Spring Clinical Meetings. “Despite guidelines recommending that RAASi discontinuation should only be used as a last resort in these patients, RAASi therapy is underused.
“We hypothesized that treatment with patiromer, a novel potassium binder, will result in lowering of serum potassium (sK+) levels, which in turn will facilitate guideline-directed medical therapy in patients with comorbid HFrEF and CKD.”
RAASi are kidney and heart protective blood pressure medications that can include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and mineralocorticoid receptor antagonists (MRAs).
At a session on late-breaking trials, Weir discussed the results of the DIAMOND trial, which enrolled 1,195 patients with HFrEF or a history of hyperkalemia due to RAASi. Patients were optimized on RAASi therapy during a 12-week period, including the use of MRAs and patiromer.
In the study group, 878 patients who successfully completed the run-in phase were then randomized to either continue using patiromer or placebo.
Results of the study showed patients in the placebo group had a higher rate of cardiovascular-related hospitalizations compared with the patiromer-treated group and had a statistically significant higher number of toxicity events – greater than 10 percentage points – when serum potassium levels were between 5 mmol/L to 6 mmol/L.
“Most patients with HFrEF and RAASi-related hyperkalemia could achieve optimal doses of RAASi including an MRA when treated with patiromer while maintaining normal serum potassium levels,” Weir said. “Overall, use of patiromer lead to a 35% relative risk reduction in the total number of hyperkalemic events. The win ratio for morbidity-adjusted hyperkalemic events and the overall RAASi use score were both significantly higher with patiromer treatment.
“I think the implications for clinical practice is we need to use these drugs,” Weir said. “They are disease modifying, life sustaining, and the current analysis is the largest clinical experience of any potassium binder to date.”
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Weir M, et al. Patiromer for the management of hyperkalemia in heart failure patients with reduced ejection fraction receiving renin-angiotensin-aldosterone system inhibitors: Results from a prespecified chronic kidney disease subgroup analysis: The DIAMOND trials. Poster 374. Presented at: National Kidney Foundation Spring Clinical Meetings; April 5-10, 2022; Boston.
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