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Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction:the DIAMOND trial

Authors :
Butler, Javed
Anker, Stefan D.
Lund, Lars H.
Coats, Andrew J.S.
Filippatos, Gerasimos
Siddiqi, Tariq Jamal
Friede, Tim
Fabien, Vincent
Kosiborod, Mikhail
Metra, Marco
Piña, Ileana L.
Pinto, Fausto
Rossignol, Patrick
van der Meer, Peter
Bahit, Cecilia
Belohlavek, Jan
Böhm, Michael
Brugts, Jasper J.
Cleland, John G.F.
Ezekowitz, Justin
Bayes-Genis, Antoni
Gotsman, Israel
Goudev, Assen
Khintibidze, Irakli
Lindenfeld, Joann
Mentz, Robert J.
Merkely, Bela
Montes, Eliodoro Castro
Mullens, Wilfried
Nicolau, Jose C.
Parkhomenko, Aleksandr
Ponikowski, Piotr
Seferovic, Petar M.
Senni, Michele
Shlyakhto, Evgeny
Cohen-Solal, Alain
Szecsödy, Peter
Jensen, Klaus
Dorigotti, Fabio
Weir, Matthew R.
Pitt, Bertram
Butler, Javed
Anker, Stefan D.
Lund, Lars H.
Coats, Andrew J.S.
Filippatos, Gerasimos
Siddiqi, Tariq Jamal
Friede, Tim
Fabien, Vincent
Kosiborod, Mikhail
Metra, Marco
Piña, Ileana L.
Pinto, Fausto
Rossignol, Patrick
van der Meer, Peter
Bahit, Cecilia
Belohlavek, Jan
Böhm, Michael
Brugts, Jasper J.
Cleland, John G.F.
Ezekowitz, Justin
Bayes-Genis, Antoni
Gotsman, Israel
Goudev, Assen
Khintibidze, Irakli
Lindenfeld, Joann
Mentz, Robert J.
Merkely, Bela
Montes, Eliodoro Castro
Mullens, Wilfried
Nicolau, Jose C.
Parkhomenko, Aleksandr
Ponikowski, Piotr
Seferovic, Petar M.
Senni, Michele
Shlyakhto, Evgeny
Cohen-Solal, Alain
Szecsödy, Peter
Jensen, Klaus
Dorigotti, Fabio
Weir, Matthew R.
Pitt, Bertram
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