- 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.
- 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.
- 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.