Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia

被引：2

作者：

Pitt, Bertram ^{[1
]}

Anker, Stefan D. ^{[2
]}

Lund, Lars H. ^{[3
,4
]}

Coats, Andrew J. S. ^{[5
]}

Filippatos, Gerasimos ^{[6
]}

Rossignol, Patrick ^{[7
,8
,9
,10
,11
]}

Weir, Matthew R. ^{[12
]}

Friede, Tim ^{[13
,14
]}

Kosiborod, Mikhail N. ^{[15
,16
]}

Metra, Marco ^{[17
,18
]}

Boehm, Michael ^{[19
]}

Ezekowitz, Justin A. ^{[20
]}

Bayes-Genis, Antoni ^{[21
,22
]}

Mentz, Robert J. ^{[23
]}

Ponikowski, Piotr ^{[24
]}

Senni, Michele ^{[25
]}

Pina, Ileana L. ^{[26
]}

Pinto, Fausto J. ^{[27
]}

van der Meer, Peter ^{[28
]}

Bahit, Cecilia ^{[29
]}

Belohlavek, Jan ^{[30
]}

Brugts, Jasper J. ^{[31
]}

Perrin, Amandine ^{[32
]}

Waechter, Sandra ^{[32
]}

Budden, Jeffrey ^{[33
]}

Butler, Javed ^{[34
]}

机构：

[1] Univ Michigan, Dept Cardiol, 1301 Catherine St, Ann Arbor, MI 48109 USA

[2] Charite, Inst Hlth Ctr Regenerat Therapies BCRT, Dept Cardiol CVK German Heart Ctr Charite, German Ctr Cardiovasc Res DZHK,Partner Site Berli, Berlin, Germany

[3] Karolinska Inst, Dept Med, Unit Cardiol, Solna, Sweden

[4] Karolinska Univ Hosp, Dept Cardiol, Stockholm, Sweden

[5] Heart Res Inst, Sydney, NSW, Australia

[6] Natl & Kapodistrian Univ Athens, Sch Med, Athens Univ Hosp Attikon, Athens, Greece

[7] Princess Grace Hosp, Med Specialties Dept, Fontvieille, Monaco

[8] Princess Grace Hosp, Dept Nephrol, Fontvieille, Monaco

[9] Monaco Private Hemodialysis Ctr, Fontvieille, Monaco

[10] Univ Lorraine, CHRU, Ctr Invest Clin Plurithemat 14 33, INSERM,U1116, Nancy, France

[11] F CRIN INI CRCT Cardiovasc & Renal Clin Trialists, Nancy, France

[12] Univ Maryland, Sch Med, Dept Med, Div Nephrol, Baltimore, MD USA

[13] Univ Med Ctr Gottingen, Dept Med Stat, Gottingen, Germany

[14] German Ctr Cardiovasc Res DZHK, Partner Site Gottingen, Gottingen, Germany

[15] St Lukes Mid Amer Heart Inst, Dept Cardiovasc Dis, Sch Med, Kansas City, MO USA

[16] Univ Missouri Kansas City, Med Specialties Dept, Kansas City, MO USA

[17] ASST Spedali Civili, Cardiol, Brescia, Italy

[18] Univ Brescia, Brescia, Italy

[19] Saarland Univ, Klin Innere Med 3, Homburg, Germany

[20] Univ Alberta, Fac Med & Dent, Edmonton, AB, Canada

[21] Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain

[22] CIBERCV, Barcelona, Spain

[23] Duke Univ, Sch Med, Dept Med, Durham, NC USA

[24] Wroclaw Med Univ, Inst Heart Dis, Wroclaw, Poland

[25] Univ Milano Bicocca, Papa Giovanni XXIII Hosp, Cardiovasc Dept, Bergamo, Italy

[26] Cent Michigan Univ, Coll Med, Mt Pleasant, MI USA

[27] Univ Lisbon, Santa Maria Univ Hosp, Fac Med, CAML,CCUL, Lisbon, Portugal

[28] Univ Med Ctr Groningen, Fac Med & Dent, Groningen, Netherlands

[29] INECO Neurociencias Orono, Rosario, Santa Fe, Argentina

[30] Gen Univ Hosp Prague, Clin Cardiol & Angiol, Prague, Czech Republic

[31] Erasmus MC, Univ Med Ctr, Rotterdam, Netherlands

[32] CSL Vifor, Glattbrugg, Switzerland

[33] CSL Vifor, Redwood City, CA USA

[34] Univ Mississippi, Dept Med, Jackson, MS USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2024年 / 84卷 / 14期

关键词：

heart failure; hyperkalemia; patiromer; mineralocorticoid receptor antagonists; renin-angiotensin system inhibitors; REDUCED EJECTION FRACTION; POTASSIUM BINDER; EFFICACY; SAFETY;

D O I：

10.1016/j.jacc.2024.05.079

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Hyperkalemia (HK) is associated with suboptimal renin-angiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF). OBJECTIVES This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase.<br /> METHODS Patients with HFrEF and HK or past HK entered a run-in phase of <= 12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve >= 50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria).<br /> RESULTS Of 1,038 patients completing the run-in, 878 (84.6%) were randomized and 160 (15.4%) were run-in failures. Overall, 422 (40.7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40.3% vs 42.5%; P 1 / 4 0.605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76.8% to 98.6%; MRA: 35.9% to 98.6%) and past HK (RAS inhibitor: 60.5% to 98.1%; MRA: 15.6% to 98.7%). Despite not meeting the randomization criteria, an increase after runin was observed in the run-in failure group in target RAS inhibitor (52.5% to 70.6%) and MRA use (15.0% to 48.1%). This increase was observed in patients with HK (RAS inhibitor: 51.5% to 64.7%; MRA: 19.1% to 39.7%) and past HK (RAS inhibitor: 53.3% to 75.0%; MRA: 12.0% to 54.3%).<br /> CONCLUSIONS In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in. (JACC. 2024;84:1295-1308)]

引用

页码：1295 / 1308

页数：14

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