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Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial
J. Butler, SD. Anker, LH. Lund, AJS. Coats, G. Filippatos, TJ. Siddiqi, T. Friede, V. Fabien, M. Kosiborod, M. Metra, IL. Piña, F. Pinto, P. Rossignol, P. van der Meer, C. Bahit, J. Belohlavek, M. Böhm, JJ. Brugts, JGF. Cleland, J. Ezekowitz, A....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu randomizované kontrolované studie, časopisecké články, práce podpořená grantem
NLK
Free Medical Journals
od 1996 do Před 1 rokem
Open Access Digital Library
od 1996-01-01
- MeSH
- antagonisté mineralokortikoidních receptorů škodlivé účinky MeSH
- draslík MeSH
- hyperkalemie * farmakoterapie komplikace MeSH
- lidé MeSH
- renin-angiotensin systém MeSH
- srdeční selhání * komplikace farmakoterapie MeSH
- tepový objem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
AIMS: To investigate the impact of patiromer on the serum potassium level and its ability to enable specified target doses of renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: A total of 1642 patients with HFrEF and current or a history of RAASi-related hyperkalemia were screened and 1195 were enrolled in the run-in phase with patiromer and optimization of the RAASi therapy [≥50% recommended dose of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, and 50 mg of mineralocorticoid receptor antagonist (MRA) spironolactone or eplerenone]. Specified target doses of the RAASi therapy were achieved in 878 (84.6%) patients; 439 were randomized to patiromer and 439 to placebo. All patients, physicians, and outcome assessors were blinded to treatment assignment. The primary endpoint was between-group difference in the adjusted mean change in serum potassium. Five hierarchical secondary endpoints were assessed. At the end of treatment, the median (interquartile range) duration of follow-up was 27 (13-43) weeks, the adjusted mean change in potassium was +0.03 mmol/l in the patiromer group and +0.13 mmol/l in the placebo group [difference in the adjusted mean change between patiromer and placebo: -0.10 mmol/l (95% confidence interval, CI -0.13, 0.07); P < 0.001]. Risk of hyperkalemia >5.5 mmol/l [hazard ratio (HR) 0.63; 95% CI 0.45, 0.87; P = 0.006), reduction of MRA dose (HR 0.62; 95% CI 0.45, 0.87; P = 0.006), and total adjusted hyperkalemia events/100 person-years (77.7 vs. 118.2; HR 0.66; 95% CI 0.53, 0.81; P < 0.001) were lower with patiromer. Hyperkalemia-related morbidity-adjusted events (win ratio 1.53, P < 0.001) and total RAASi use score (win ratio 1.25, P = 0.048) favored the patiromer arm. Adverse events were similar between groups. CONCLUSION: Concurrent use of patiromer and high-dose MRAs reduces the risk of recurrent hyperkalemia (ClinicalTrials.gov: NCT03888066).
Alexandre Aladashvili Clinic Tbilisi State Medical University Tbilisi Georgia
Almazov Federal Heart Blood and Endocrinology Centre Saint Petersburg Russia
Baylor Scott and White Research Institute Dallas TX USA
Berlin Institute of Health Center for Regenerative Therapies Berlin Germany
Cardiology ASST Spedali Civili and University Brescia Italy
Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Barcelona CIBERCV Spain
Central Michigan University College of Medicine Mount Pleasant MI USA
Charité Universitätsmedizin Berlin Germany
Clinic of Cardiology and Angiology General University Hospital Prague Prague Czech Republic
Department of Cardiology Berlin Germany
Department of Cardiology Karolinska University Hospital Stockholm Sweden
Department of Cardiology University Medical Center Groningen Groningen the Netherlands
Department of Cardiovascular Disease Saint Luke's Mid America Heart Institute Kansas City MO USA
Department of Emergency Medicine Medical University of Sofia Sofia Bulgaria
Department of Internal Medicine Göttingen Germany
Department of Medicine Duke University School of Medicine Durham NC USA
Department of Medicine Unit of Cardiology Karolinska Institutet Solna Stockholm Sweden
Department of Medicine University of Mississippi Jackson MS USA
Department of Medicine Vanderbilt University Medical Centre Nashville TN USA
Division of Cardiology University of Michigan Ann Arbor MI USA
DZHK Göttingen partner site Göttingen Germany
Erasmus MC University Medical Center Rotterdam the Netherlands
Faculty of Medicine and Dentistry University of Alberta Alberta Canada
Faculty of Medicine Belgrade Serbia
German Center for Cardiovascular Research partner site Berlin Berlin Germany
Hadassah Medical Centre Jerusalem Israel
Heart Institute of Queretaro Santiago de Querétaro Mexico City Mexico
Hospital Attikon Athens Greece
Hospital Oost Limburg Genk Belgium
INECO Neurociencias Oroño Rosario Santa Fe NM USA
Insitute of Heart Diseases Wroclaw Medical University Wroclaw Poland
Institute of Health and Wellbeing University of Glasgow Glasgow UK
Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina
Klinik für Innere Medizin 3 Saarland University Homburg Saar Germany
National and Kapodistrian University of Athens School of Medicine Athens University Athens Greece
Semmelweis University Heart and Vascular Center Budapest Hungary
Serbian Academy of Sciences and Arts Serbia
Universidade de Sao Paulo Sao Paulo SP Brazil
Université de Paris INSERM U942 APHP Hospital Lariboisiere Paris France
University Medical Center Göttingen Göttingen Germany
University of Milano Bicocca Cardiovascular Department Papa Giovanni XXIII Hospital Bergamo Italy
University of Missouri Kansas City Kansas City MO USA
University of Warwick Warwick UK
Citace poskytuje Crossref.org
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