Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia
Pitt, Bertram (University of Michigan)
Anker, Stefan (Charité-Universitätsmedizin Berlin)
Lund, Lars H (Karolinska University Hospital)
Coats, Andrew J.S. (Heart Research Institute)
Filippatos, Gerasimos (National and Kapodistrian University of Athens)
Rossignol, Patrick (Université de Lorraine)
Weir, Matthew R. (University of Maryland School of Medicine)
Friede, Tim (DZHK (German Center for Cardiovascular Research))
Kosiborod, Mikhail N. (Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City)
Metra, Marco (ASST Spedali Civili and University)
Böhm, Michael (Saarland University)
Ezekowitz, Justin A. (University of Alberta)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Mentz, Robert J. (Duke University School of Medicine)
Ponikowski, Piotr (Wroclaw Medical University)
Senni, Michele (University of Milano - Bicocca)
Piña, Ileana L. (Central Michigan University College of Medicine)
Pinto, Fausto J. (Santa Maria University Hospital)
van der Meer, Peter (University Medical Center Groningen)
Bahit, Maria Cecilia (INECO Neurociencias Oroño)
Belohlavek, Jan (General University Hospital Prague)
Brugts, Jasper J. (Erasmus MC University Medical Center)
Perrin, Amandine (CSL Vifor)
Waechter, Sandra (CSL Vifor)
Budden, Jeffrey (CSL Vifor)
Butler, Javed (Department of Medicine. University of Mississippi)

Data:	2024
Resum:	Background: Hyperkalemia (HK) is associated with suboptimal renin-angiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF). Objectives: This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase. Methods: Patients with HFrEF and HK or past HK entered a run-in phase of ≤12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve ≥50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria). Results: Of 1,038 patients completing the run-in, 878 (84. 6%) were randomized and 160 (15. 4%) were run-in failures. Overall, 422 (40. 7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40. 3% vs 42. 5%; P = 0. 605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76. 8% to 98. 6%; MRA: 35. 9% to 98. 6%) and past HK (RAS inhibitor: 60. 5% to 98. 1%; MRA: 15. 6% to 98. 7%). Despite not meeting the randomization criteria, an increase after run-in was observed in the run-in failure group in target RAS inhibitor (52. 5% to 70. 6%) and MRA use (15. 0% to 48. 1%). This increase was observed in patients with HK (RAS inhibitor: 51. 5% to 64. 7%; MRA: 19. 1% to 39. 7%) and past HK (RAS inhibitor: 53. 3% to 75. 0%; MRA: 12. 0% to 54. 3%). Conclusions: In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Heart failure ; Hyperkalemia ; Mineralocorticoid receptor antagonists ; Patiromer ; Renin-angiotensin system inhibitors
Publicat a:	Journal of the American College of Cardiology, Vol. 84 Núm. 14 (january 2024) , p. 1295-1308, ISSN 1558-3597

DOI: 10.1016/j.jacc.2024.05.079
PMID: 39322323

14 p, 713.2 KB

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