In older CKD patients taking RAAS inhibitors, patiromer reduced serum potassium by 1.01 mEq/L at 4 weeks (P<0.001) and prevented recurrent hyperkalemia compared to placebo (30% vs 92%).
RCT
randomized
Does patiromer reduce serum potassium and prevent recurrent hyperkalemia in older patients (≥65 years) with chronic kidney disease taking RAAS inhibitors?
Patiromer effectively reduces serum potassium and prevents recurrent hyperkalemia in older patients with chronic kidney disease on RAAS inhibitors.
p-value: p=< .001
BACKGROUND: Older people are predisposed to hyperkalemia because of impaired renal function, comorbid conditions, and polypharmacy. Renin-angiotensin-aldosterone system inhibitors (RAASi), which are recommended to treat chronic kidney disease and heart failure augment the risk. Patiromer, a nonabsorbed potassium binder, was shown in the phase 3 OPAL-HK study to decrease serum potassium in patients with chronic kidney disease taking RAASi. We studied the efficacy and safety of patiromer in a prespecified subgroup of patients aged ≥65 years from OPAL-HK. METHODS: Chronic kidney disease patients with mild or moderate-to-severe hyperkalemia received patiromer, initially 8.4 g/d or 16.8 g/d, respectively, for 4 weeks (treatment phase, part A). Eligible patients entered an 8-week randomized withdrawal phase (part B) and continued patiromer or switched to placebo. RESULTS: Mean ± standard error change in serum potassium from baseline to week 4 of part A (primary endpoint) in patients aged ≥65 years was -1.01 ± 0.05 mEq/L (P < .001); 97% achieved serum potassium 3.8-<5.1 mEq/L. The serum potassium increase during the first 4 weeks of part B was greater in patients taking placebo than in those taking patiromer (P < .001). Fewer patients taking patiromer (30%) than placebo (92%) developed recurrent hyperkalemia (serum potassium ≥5.1 mEq/L). Mild-to-moderate constipation occurred in 15% (part A) and 7% (part B) of patients aged ≥65 years. Serum potassium <3.5 mEq/L and serum magnesium <1.4 mg/dL were infrequent (4% each in patients aged ≥65 years in part A). CONCLUSIONS: Patiromer reduced recurrent hyperkalemia and was well tolerated in older chronic kidney disease patients taking RAASi.
Weir et al. (Sun,) führten eine RCT bei chronischer Nierenerkrankung mit Hyperkaliämie durch. Patiromer vs. Placebo wurde hinsichtlich der Veränderung des Serumkaliums von der Basislinie bis zur Woche 4 von Teil A (p=< .001) bewertet. Bei älteren CKD-Patienten, die RAAS-Inhibitoren einnahmen, reduzierte Patiromer das Serumkalium nach 4 Wochen um 1,01 mEq/L (P<0,001) und verhinderte im Vergleich zu Placebo wiederkehrende Hyperkaliämie (30 % vs. 92 %).