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Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia
B. Pitt, SD. Anker, LH. Lund, AJS. Coats, G. Filippatos, P. Rossignol, MR. Weir, T. Friede, MN. Kosiborod, M. Metra, M. Böhm, JA. Ezekowitz, A. Bayes-Genis, RJ. Mentz, P. Ponikowski, M. Senni, IL. Piña, FJ. Pinto, P. van der Meer, C. Bahit, J....
Language English Country United States
Document type Journal Article, Randomized Controlled Trial, Multicenter Study
NLK
Free Medical Journals
from 1983 to 1 year ago
Open Access Digital Library
from 1998-01-01
- MeSH
- Mineralocorticoid Receptor Antagonists * therapeutic use MeSH
- Angiotensin Receptor Antagonists therapeutic use MeSH
- Hyperkalemia * drug therapy blood MeSH
- Angiotensin-Converting Enzyme Inhibitors therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Polymers * therapeutic use MeSH
- Renin-Angiotensin System drug effects MeSH
- Aged MeSH
- Heart Failure * drug therapy MeSH
- Stroke Volume drug effects MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
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.
Cardiology ASST Spedali Civili and University Brescia Italy
Central Michigan University College of Medicine Mount Pleasant Michigan USA
Clinic of Cardiology and Angiology General University Hospital Prague Prague Czech Republic
CSL Vifor Glattbrugg Switzerland
CSL Vifor Redwood City California USA
Department of Cardiology Karolinska University Hospital Stockholm Sweden
Department of Cardiology partner site Berlin Charité Universitätsmedizin Berlin Germany
Department of Cardiology University Medical Center Groningen Groningen the Netherlands
Department of Medical Statistics University Medical Center Göttingen Göttingen Germany
Department of Medicine Duke University School of Medicine Durham North Carolina USA
Department of Medicine Unit of Cardiology Karolinska Institutet Solna Sweden
Department of Medicine University of Mississippi Jackson Mississippi USA
Division of Cardiology University of Michigan Ann Arbor Michigan USA
DZHK partner site Göttingen Göttingen Germany
Erasmus MC University Medical Center Rotterdam the Netherlands
Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
Heart Research Institute Sydney Australia
INECO Neurociencias Oroño Rosario Santa Fe Argentina
Institute of Heart Diseases Wroclaw Medical University Wroclaw Poland
Klinik für Innere Medizin 3 Saarland University Homburg Saar Germany
University of Milano Bicocca Cardiovascular Department Papa Giovanni XXIII Hospital Bergamo Italy
References provided by Crossref.org
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