title: Effectiveness of patiromer in the treatment of hyperkalemia in chronic kidney disease patients with hypertension on diuretics.
abstract: Recurrent hyperkalemia frequently limits use of renin-angiotensin-aldosterone system inhibitors (RAASi) in chronic kidney disease (CKD) patients with hypertension, diabetes, and/or heart failure. Patiromer is a sodium-free, nonabsorbed potassium (K)-binding polymer approved by the US Food and Drug Administration for the treatment of hyperkalemia. This post-hoc analysis of OPAL-HK examined the effectiveness and safety of patiromer in reducing serum K in hyperkalemic CKD patients on RAASi, with hypertension, receiving diuretic therapy versus those not on diuretics.
  
  
  
  Depending on the degree of hyperkalemia at baseline, CKD patients with serum K from 5.1 to less than 6.5 mmol/l on RAASi (n = 243) were assigned to a patiromer of total dose 8.4 or 16.8 g, divided twice daily. Changes in serum K, and tolerability and safety were assessed over 4 weeks in patients on and not on diuretics.
  
  
  
  At baseline, 132 patients used diuretics and 111 were not on diuretics, mean age was 64.3 and 64.0 years, respectively, and 63 and 51% were men. Similar reductions in serum K were seen over 4 weeks in both subgroups. At week 4, serum K fell by -0.95 ± 0.04 mmol/l with any diuretic and -1.04 ± 0.05 mmol/l with no diuretic. Patiromer was well tolerated, with mild-to-moderate constipation reported as the most common adverse event (7.6 and 14.4% of patients on any diuretic or no diuretic, respectively). Hypokalemia (s-K <3.5 mEq/l) was reported in 2.3% of patients on any diuretic and in 3.7% not on diuretics.
  
  
  
  The serum K-lowering efficacy and safety profile of patiromer in hyperkalemia patients with CKD was not compromised by diuretic therapy.
authors.affiliation: aDivision of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland bRelypsa, Inc., Redwood City, California cDivision of Nephrology, Department of Medicine, University of Rochester School of Medicine, Rochester, New York dDivision of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: Martha R
authors.initials: MR
authors.lastname: Mayo
authors.forename: Dahlia
authors.initials: D
authors.lastname: Garza
authors.forename: Susan A
authors.initials: SA
authors.lastname: Arthur
authors.forename: Lance
authors.initials: L
authors.lastname: Berman
authors.forename: David
authors.initials: D
authors.lastname: Bushinsky
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wilson
authors.forename: Murray
authors.initials: M
authors.lastname: Epstein
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002614:Chelating Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007008:Hypokalemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000009:adverse effects / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002614:Chelating Agents; D004232:Diuretics; D011108:Polymers; C568789:patiromer; D011188:Potassium