Key result
Patiromer achieved target serum potassium levels in 85% of patients taking RAAS inhibitors and 84% of those not taking them, with no significant difference between groups.
Why the study?
Does patiromer reduce serum potassium in hyperkalemic patients regardless of RAAS inhibitor use?
Does patiromer reduce serum potassium in hyperkalemic patients regardless of RAAS inhibitor use?
Patiromer effectively lowers serum potassium and is generally well-tolerated in hyperkalemic patients, regardless of concurrent RAAS inhibitor use.
Answers are grounded in this paper and cite their sources.
Supports patiromer for potassium control irrespective of RAAS inhibitor use; leaves open its role in enabling RAASi continuation.
INTRODUCTION: Hyperkalemia (potassium >5.0 mEq/L) affects heart failure patients with renal disease regardless of the use of renin-angiotensin-aldosterone system inhibitors (RAASi). The open-label TOURMALINE study showed that patiromer, a sodium-free, nonabsorbed potassium binder, lowers serum potassium of hyperkalemic patients similarly when given with or without food; unlike prior studies, patients were not required to be taking RAASi. We conducted post hoc analyses to provide the first report of patiromer in patients not taking RAASi. METHODS: Hyperkalemic patients received patiromer, 8.4 g/d to start, adjusted to achieve and maintain serum potassium of 3.8 to 5.0 mEq/L. If taking RAASi, stable doses were required. The primary end point was the proportion of patients with serum potassium 3.8 to 5.0 mEq/L at week 3 or 4. This analysis presents data by patients taking or not taking RAASi. RESULTS: Demographics and baseline characteristics were similar in patients taking (n = 67) and not taking RAASi (n = 45). Baseline mean (SD) serum potassium was 5.37 (0.37) mEq/L and 5.42 (0.43) mEq/L in patients taking and not taking RAASi, respectively. Mean (SD) daily patiromer doses were similar (10.7 [3.2] and 11.5 [4.0] g, respectively). The primary end point was achieved in 85% (95% confidence interval [CI]: 74-93) of patients taking RAASi and in 84% (95% CI: 71-94) of patients not taking RAASi. From baseline to week 4, the mean (SE) change in serum potassium was -0.67 (0.08) mEq/L in patients taking RAASi and -0.56 (0.10) mEq/L in patients not taking RAASi (both P < .0001 vs baseline, P = nonsignificant between groups). Adverse events were reported in 26 (39%) patients taking RAASi and 25 (54%) not taking RAASi; the most common adverse event was diarrhea (2% and 11%, respectively; no cases were severe). Five patients (2 taking RAASi) reported 6 serious adverse events; none considered related to patiromer. CONCLUSIONS: Patiromer was effective and generally well-tolerated for hyperkalemia treatment, whether or not patients were taking RAAS inhibitors.
No takes yet. Share an insight, caveat, or question.
Kloner et al. (2018) studied Hyperkalemia (n=112). Patiromer vs. Patients not taking RAASi was evaluated on proportion of patients with serum potassium 3.8 to 5.0 mEq/L at week 3 or 4 (p=nonsignificant). Patiromer achieved target serum potassium levels in 85% of patients taking RAAS inhibitors and 84% of those not taking them, with no significant difference between groups.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: