Patiromer for Hyperkalemia in Patients With and Without Diabetes

The gold standard therapy for patients with heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) is treatment with renin-angiotensin-aldosterone system inhibitors (RAASi). According to Gerasimos Filippatos, MD, National and Kapodistrian University of Athens, Athens, Greece, suboptimal RAASi use has been associated with hyperkalemia.

Results of the DIAMOND trial demonstrated that treatment with patiromer, a  novel potassium binder, maintained lower serum potassium compared with placebo and facilitated optimal RAASi therapy, including mineralocorticoid receptor antagonists (MRAs) in patients with HFrEF. Dr. Filippatos conducted a prespecified analysis of patient subgroups with and without diabetes in the DIAMOND trial.

Results were reported during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled Patiromer for Hyperkalemia Management in Patients Receiving Renin-Angiotensin-Aldosterone System Inhibitors for Heart Failure (DIAMOND): Prespecified Analysis of Patients With or Without Diabetes.

The analysis included patients with HFrEF with current hyperkalemia or a history of hyperkalemia who entered a single-blinded run-in phase of up to 12 weeks for optimization of patiromer and RAASIs. Following the run-in period, patients were randomized to receive either double-blind continued patiromer or placebo (patiromer withdrawal).

The primary end point was mean change in serum potassium from baseline to the end of the trial. Secondary end points were serum potassium >5.5 mEq/L, durable enablement of MRA at target dose, adverse events related to hyperkalemia, hyperkalemia-related hard outcome end points, and a win ratio of novel RAASi use score based on the sequence of all-cause mortality, hospitalization related to cardiovascular causes, and RAASi use.

A total of 1195 patients entered the run-in phase. Of those, 878 were randomized. A total of 356 randomized patients (41%) had diabetes. The treatment effect of patiromer compared with placebo was consistent in patients with and without diabetes.

“Patiromer can effectively control serum potassium and facilitate optimization of MRAs in patients with HFrEF irrespective of diabetes,” Dr. Filippatos said.

Source: Filippatos G. Patiromer for hyperkalemia management in patients receiving renin-angiotensin-aldosterone system inhibitors for heart failure (DIAMOND): prespecified analysis of patients with and without diabetes. TH-PO604. Abstract of a poster presented during the American Society of Nephrology Kidney Week 2022; November 3, 2022; Orlando, Florida.