title: Treatment with patiromer decreases aldosterone in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors.
abstract: Elevated serum aldosterone can be vasculotoxic and facilitate cardiorenal damage. Renin-angiotensin system inhibitors reduce serum aldosterone levels and/or block its effects but can cause hyperkalemia. Patiromer, a nonabsorbed potassium binder, decreases serum potassium in patients with chronic kidney disease on renin-angiotensin system inhibitors. Here we examined the effect of patiromer treatment on serum aldosterone, blood pressure, and albuminuria in patients with chronic kidney disease on renin-angiotensin system inhibitors with hyperkalemia (serum potassium 5.1-6.5 mEq/l). We analyzed data from the phase 3 OPAL-HK study (4-week initial treatment phase of 243 patients; 8-week randomized withdrawal phase of 107 patients). In the treatment phase, the (mean ± standard error) serum potassium was decreased concordantly with the serum aldosterone (-1.99 ± 0.51 ng/dl), systolic/diastolic blood pressure (-5.64 ± 1.04 mm Hg/-3.84 ± 0.69 mm Hg), and albumin-to-creatinine ratio (-203.7 ± 54.7 mg/g), all in a statistically significant manner. The change in the plasma renin activity (-0.44 ± 0.63 μg/l/hr) was not significant. In the withdrawal phase, mean aldosterone levels were sustained with patiromer (+0.23 ± 1.07 ng/dl) and significantly increased with placebo (+2.78 ± 1.25 ng/dl). Patients on patiromer had significant reductions in mean systolic/diastolic blood pressure (-6.70 ± 1.59/-2.15 ± 1.06 mm Hg), whereas those on placebo did not (-1.21 ± 1.89 mm Hg/+1.72 ± 1.26 mm Hg). Significant changes in plasma renin activity were found only in the placebo group (-3.90 ± 1.41 μg/l/hr). Thus, patiromer reduced serum potassium and aldosterone levels independent of plasma renin activity in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA. Electronic address: mweir@medicine.umaryland.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.affiliation: Relypsa, Redwood City, California, USA.
authors.forename: Coleman
authors.initials: C
authors.lastname: Gross
authors.affiliation: Relypsa, Redwood City, California, USA.
authors.forename: Martha R
authors.initials: MR
authors.lastname: Mayo
authors.affiliation: Relypsa, Redwood City, California, USA.
authors.forename: Dahlia
authors.initials: D
authors.lastname: Garza
authors.affiliation: Relypsa, Redwood City, California, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Stasiv
authors.affiliation: Relypsa, Redwood City, California, USA.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Yuan
authors.affiliation: Relypsa, Redwood City, California, USA.
authors.forename: Lance
authors.initials: L
authors.lastname: Berman
authors.affiliation: Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Williams
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000652:urine; D000450:Aldosterone / Q000097:blood*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D011108:Polymers / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects*; D000092502:Renin Inhibitors
chemical_list: D000450:Aldosterone; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D011108:Polymers; D011188:Potassium; D012083:Renin; D000092502:Renin Inhibitors; C568789:patiromer
keywords: ACE inhibitors; aldosterone; cardiovascular disease; chronic kidney disease; renin angiotensin system