|The following article features coverage from Kidney Week 2019. Click here to read more of Renal & Urology News’ conference coverage.|
WASHINGTON—New study findings confirm the effectiveness of patiromir—a non-absorbed potassium-binding polymer used to treat hyperkalemia—at prolonging use of the blood pressure-lowering drug spironolactone in patients with advanced chronic kidney disease (CKD) and resistant hypertension, according to a presentation at the American Society of Nephrology’s 2019 Kidney Week meeting.
Spironolactone is effective at decreasing blood pressure in patients with resistant hypertension, but its use frequently is limited by hyperkalemia.
The new findings are from a subsequent analysis of the phase 2 AMBER trial in which investigators led by Rajiv Agarwal, MD, of the Indiana University School of Medicine in Indianapolis, randomly assigned 295 patients with uncontrolled resistant hypertension and an estimated glomerular filtration rate (eGFR) of 25 to 45 mL/min/1.73 m2 to receive spironolactone or placebo. Patiromer enabled more persistent use of spironolactone. At week 12, 86% of the patiromer-treated patients remained on spironolactone compared with 66% of placebo recipients, according to study findings published online September 13 in The Lancet.
In the new analysis, Dr Agarwal and his colleagues examined the effect of patiromer on spironolactone use in 2 prespecified subgroups: patients with an eGFR below 30 (CKD stage 4 CKD) and 30 mL/min/1.73 m2 or higher (CKD stage 3). In both subgroups, significantly greater proportions of patients treated with patiromer remained on spironolactone compared with placebo recipients at week 12 (84.4% vs 55.9% among patients with an eGFR below 30 mL/min/1.73 m2 and 86.1% vs 69.3% among patients with an eGFR of 30 mL/min/1.73 m2 or higher). The influence of patiromer on persistence of spironolactone use did not differ significantly between the subgroups.
Adverse events occurred in 63% of patiromer-treated patients and 56% of placebo recipients among those in the lower eGFR subgroup and 54% and 53%, respectively, of those in the higher eGFR subgroups.
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Agarwal R, Rossingnol P, Mayo M, et al. Patiromer vs. placebo to enable spironolactone in patients with resistant hypertension and CKD according to baseline kidney function (AMBER Trial). Presented in an oral session on November 7, 2019 at the American Society of Nephrology’s annual Kidney Week conference in Washington, DC. Abstract TH-OR052.