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Patiromer for Heart Failure Medication Optimization in Patients With Current or Past Hyperkalemia: DIAMOND

Andrew J S Coats1, Stefan D Anker2, Lars H Lund3

  • 1Heart Research Institute, Sydney, New South Wales, Australia.

JACC. Heart Failure
|September 28, 2024
PubMed

Insights

Patiromer helps manage hyperkalemia in heart failure patients, enabling optimal use of renin-angiotensin-aldosterone system inhibitors (RAASis). It proved effective in lowering potassium levels and maintaining mineralocorticoid receptor antagonist (MRA) target doses, especially in patients with current hyperkalemia.

Area of Science:

  • Cardiology
  • Pharmacology
  • Nephrology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) treatment is often limited by hyperkalemia, leading to suboptimal use of renin-angiotensin-aldosterone system inhibitors (RAASis).
  • Potassium binders offer a potential solution to mitigate hyperkalemia, thereby improving RAASi therapy adherence and efficacy in HFrEF patients.

Purpose of the Study:

  • To assess the efficacy of patiromer in managing hyperkalemia in patients with HFrEF.
  • To evaluate patiromer's effect on achieving target doses of RAASis, including mineralocorticoid receptor antagonists (MRAs), in patients with current or past hyperkalemia.

Main Methods:

  • A prespecified analysis of the phase 3 DIAMOND trial involving patients with HFrEF and current or past hyperkalemia.
  • Patients underwent a run-in phase to optimize RAASis with patiromer, followed by randomization to continue patiromer or switch to placebo in a double-blind manner.
  • Serum potassium (sK+) levels and MRA treatment adherence were monitored throughout the study.

Main Results:

  • Patiromer significantly lowered serum potassium levels compared to placebo in both current and past hyperkalemia subgroups.
  • Patiromer was more effective in maintaining MRA at target doses for patients with current hyperkalemia compared to those with past hyperkalemia.
  • Adverse events were comparable between the patiromer and placebo groups and across hyperkalemia subgroups.

Conclusions:

  • Patiromer facilitates the achievement and maintenance of target RAASi doses in HFrEF patients experiencing hyperkalemia.
  • The use of patiromer appears particularly beneficial for patients with current hyperkalemia, aiding in potassium control and MRA dose optimization.
  • Patiromer is a safe and effective option for managing hyperkalemia in HFrEF patients, thereby improving the utilization of guideline-directed medical therapy.
Abstract

Keywords:
heart failure with reduced ejection fractionhyperkalemiapatiromerpotassium binderrenin-angiotensin-aldosterone system inhibitor

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