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Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction:the DIAMOND trial
- Source :
- Butler , J , Anker , S D , Lund , L H , Coats , A J S , Filippatos , G , Siddiqi , T J , Friede , T , Fabien , V , Kosiborod , M , Metra , M , Piña , I L , Pinto , F , Rossignol , P , van der Meer , P , Bahit , C , Belohlavek , J , Böhm , M , Brugts , J J , Cleland , J G F , Ezekowitz , J , Bayes-Genis , A , Gotsman , I , Goudev , A , Khintibidze , I , Lindenfeld , J , Mentz , R J , Merkely , B , Montes , E C , Mullens , W , Nicolau , J C , Parkhomenko , A , Ponikowski , P , Seferovic , P M , Senni , M , Shlyakhto , E , Cohen-Solal , A , Szecsödy , P , Jensen , K , Dorigotti , F , Weir , M R & Pitt , B 2022 , ' Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction : the DIAMOND trial ' , European Heart Journal , vol. 43 , no. 41 , pp. 4362-4373 .
- Publication Year :
- 2022
-
Abstract
- AIMS: To investigate the impact of patiromer on the serum potassium level and its ability to enable specified target doses of renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: A total of 1642 patients with HFrEF and current or a history of RAASi-related hyperkalemia were screened and 1195 were enrolled in the run-in phase with patiromer and optimization of the RAASi therapy [≥50% recommended dose of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, and 50 mg of mineralocorticoid receptor antagonist (MRA) spironolactone or eplerenone]. Specified target doses of the RAASi therapy were achieved in 878 (84.6%) patients; 439 were randomized to patiromer and 439 to placebo. All patients, physicians, and outcome assessors were blinded to treatment assignment. The primary endpoint was between-group difference in the adjusted mean change in serum potassium. Five hierarchical secondary endpoints were assessed. At the end of treatment, the median (interquartile range) duration of follow-up was 27 (13-43) weeks, the adjusted mean change in potassium was +0.03 mmol/l in the patiromer group and +0.13 mmol/l in the placebo group [difference in the adjusted mean change between patiromer and placebo: -0.10 mmol/l (95% confidence interval, CI -0.13, 0.07); P < 0.001]. Risk of hyperkalemia >5.5 mmol/l [hazard ratio (HR) 0.63; 95% CI 0.45, 0.87; P = 0.006), reduction of MRA dose (HR 0.62; 95% CI 0.45, 0.87; P = 0.006), and total adjusted hyperkalemia events/100 person-years (77.7 vs. 118.2; HR 0.66; 95% CI 0.53, 0.81; P < 0.001) were lower with patiromer. Hyperkalemia-related morbidity-adjusted events (win ratio 1.53, P < 0.001) and total RAASi use score (win ratio 1.25, P = 0.048) favored the patiromer arm. Adverse events were similar between groups. CONCLUSION: Concurrent use of patiromer and high-dose MRAs re
Details
- Database :
- OAIster
- Journal :
- Butler , J , Anker , S D , Lund , L H , Coats , A J S , Filippatos , G , Siddiqi , T J , Friede , T , Fabien , V , Kosiborod , M , Metra , M , Piña , I L , Pinto , F , Rossignol , P , van der Meer , P , Bahit , C , Belohlavek , J , Böhm , M , Brugts , J J , Cleland , J G F , Ezekowitz , J , Bayes-Genis , A , Gotsman , I , Goudev , A , Khintibidze , I , Lindenfeld , J , Mentz , R J , Merkely , B , Montes , E C , Mullens , W , Nicolau , J C , Parkhomenko , A , Ponikowski , P , Seferovic , P M , Senni , M , Shlyakhto , E , Cohen-Solal , A , Szecsödy , P , Jensen , K , Dorigotti , F , Weir , M R & Pitt , B 2022 , ' Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction : the DIAMOND trial ' , European Heart Journal , vol. 43 , no. 41 , pp. 4362-4373 .
- Notes :
- application/pdf, English
- Publication Type :
- Electronic Resource
- Accession number :
- edsoai.on1356652895
- Document Type :
- Electronic Resource