Patiromer Benefits High-Risk Hyperkalemic Patients

The medication significantly decreased potassium levels over 52 weeks in patients with resistant hypertension and diabetic kidney disease.
The medication significantly decreased potassium levels over 52 weeks in patients with resistant hypertension and diabetic kidney disease.

Patiromer can provide long-term control of hyperkalemia in patients with resistant hypertension and diabetic kidney disease, according to a study presented at the American Heart Association Scientific Sessions in Orlando.

Murray Epstein, MD, of the University of Miami Leonard M. Miller School of Medicine, and colleagues conducted a post hoc analysis of the 52-week AMETHYST-DN study, which investigated the potassium-lowering effect of patiromer among 306 hypertensive patients with mild and moderate hyperkalemia and diabetic kidney disease on renin-angiotensin-aldosterone system (RAAS) inhibitors. Patients were treated with patiromer in an 8-week initiation phase followed by a 44-week long-term maintenance phase. Seventy-nine patients—64 with mild and 15 with moderate hyperkalemia—had resistant hypertension (baseline systolic BP greater than 140 mmHg on 4 or more classes of antihypertensive medication, including a diuretic) while on RAAS inhibitors. 

At baseline, the 79 patients had a mean (SD) heart rate and systolic and diastolic pressure of 73 (9.9) beats per minute and 156 (10.2) and 83(11.7) mm Hg, respectively. Also at baseline, 51 (65%) of the 79 patients had stage 3b or higher chronic kidney disease. The researchers observed significant decreases in mean serum potassium level at each time point over the 52-week study period. Of the 79 patients, 5 withdrew from the study because of patiromer-related adverse events.

It is possible that control of serum potassium with patiromer allowed for continuation of RAAS inhibitor therapy and/or maximal RAAS inhibitor dose, according to the investigators.

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