Long-term effect of patiromer for hyperkalemia treatment in patients with chronic kidney disease, heart failure, and ejection fraction >40% on RAAS inhibitors

Background Patients with heart failure and chronic kidney disease (CKD) on RAAS inhibitors have a high risk of hyperkalemia, which can increase risk of mortality and lead to RAAS inhibitor dose reduction or discontinuation. Patiromer, a sodium-free nonabsorbed K+-binding polymer that exchanges calcium for K+, is approved for the treatment of hyperkalemia. Previously, we showed that patiromer reduced mean serum K+ over 52 weeks in a small (n=26) subgroup of patients with heart failure with reduced ejection fraction (≤40%) in the AMETHYST-DN study. Methods Patients with CKD, type 2 diabetes mellitus, and hyperkalemia (baseline serum K+ u003e5.0 to 40%. Conclusion Patiromer decreased serum K+ through 52 weeks in patients with hyperkalemia, chronic kidney disease, and heart failure with EFu003e40%, all of whom were taking RAAS inhibitors. These post-hoc results require prospective evaluation, but suggest that patiromer allows control of hyperkalemia in heart failure patients with EF u003e40% on RAAS inhibitors. Result Overall, 55 out of 306 randomized patients had heart failure with EF u003e40% (100% Caucasian, 75% male, 69% ≥65 years of age). Mean (SD) EF was 48 (7)% and mean (SD) eGFR was 41 (13) mL/min/1.73 m² at baseline. All patients had hypertension (mean BP 155/83 mm Hg). Mean serum K+ was reduced to