NKF 2019—Patiromer allows patients with CKD to remain on spironolactone


  • Richard Robinson
  • Conference Reports
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Takeaway

  • Patients with treatment-resistant hypertension and advanced chronic kidney disease (CKD) can maintain spironolactone with a lower risk of potassium elevation.

Why this matters

  • Treatment-resistant hypertension is common in CKD, but CKD is a risk factor for hyperkalemia under spironolactone treatment.
  • Patiromer is indicated for treatment of hyperkalemia.

Study design

  • Randomized, international, multicenter trial of 12 weeks of spironolactone + placebo vs spironolactone + patiromer (n=295).
  • Patients had:
    • uncontrolled hypertension while taking at least 3 antihypertensive medications,
    • estimated glomerular filtration rate of 25-45 mL/minute/1.73 m2 (advanced CKD).
  • Primary endpoint: Between-group difference in the proportion of subjects remaining on spironolactone at week 12.
  • Funding: Relypsa.

Key results

  • At 12 weeks, 86% of patients on patiromer vs 66% of patients on placebo remained on spironolactone (least-squares [LS] difference between groups, 20%; 95% CI, 10%-29%; P<.0001>
  • Patiromer favored for:
    • time to discontinuation of spironolactone (P=.0001),
    • time to serum K+ ≥5.5 mEq/L (P≤.0001),
    • cumulative dose of spironolactone (LS mean difference between groups: 385 mg; 95% CI, 140-629; P=.0021).
  • No difference in BP control between groups.
  • No treatment-attributed serious adverse events.