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Evaluation of an individualized dose titration regimen of patiromer to prevent hyperkalaemia in patients with heart failure and chronic kidney disease [Elektronski vir]Pitt, Bertram, 1932- ...Hyperkalaemia risk precludes optimal renin-angiotensin-aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a ... sodium-free, non-absorbed potassium (K+ )-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16.4 g/day) followed by individualized titration in preventing hyperkalaemia and hypokalaemia when initiating spironolactone. METHODS AND RESULTS: This open-label 8-week study enrolled 63 patients with CKD, serum K+ 4.3-5.1 mEq/L, and chronic HF, who, based on investigator opinion, should receive spironolactone. Eligible patients started spironolactone 25 mg/day and patiromer 16.8 g/day (divided into two doses), with patiromer titrated to maintain serum K+ 4.0-5.1 mEq/L. Mean (standard deviation) serum K+ was 4.78 (0.51) mEq/L at baseline; weekly values were 4.48-4.70 mEq/L during treatment. Serum K+ of 3.5-5.5 mEq/L at the end of study treatment (primary endpoint) was achieved by 57 (90.5%) patients; 53 (84.1%) had serum K+ 4.0-5.1 mEq/L. One patient (1.6%) developed hypokalaemia, and two patients (3.2%) developed hypomagnesaemia. Spironolactone was increased to 50 mg/day in all patients; 43 (68%) patients required one or more patiromer dose titration. Adverse events (AEs) occurred in 36 (57.1%) patients, with a low rate of discontinuations [four (6.3%) patients]. The most common AE was mild to moderate abdominal discomfort [four (6.3%) patients]. CONCLUSIONS: In this open-label study, patiromer 16.8 g/day followed by individualized titration maintained serum K+ within the target range in the majority of patients with HF and CKD, all of whom were uptitrated to spironolactone 50 mg/day, patiromer was well tolerated, with a low incidence of hyperkalaemia, hypokalaemia, and hypomagnesaemia.Type of material - e-articlePublish date - 2018Language - englishCOBISS.SI-ID - 2864251
Author
Pitt, Bertram, 1932- |
Bushinsky, David A. |
Kitzman, Delane W. |
Ruschitzka, Frank |
Metra, Marco |
Filippatos, Gerasimos |
Rossignol, Patrick |
Du Mond, Charles |
Garza, Dahlia |
Berman, Lance |
Lainščak, Mitja
Topics
srčno popuščanje |
hiperkaliemija |
kronična ledvična okvara |
klinične študije |
heart failure |
hyperkalaemia |
chronic kidney disease |
clinical studies
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Pitt, Bertram, 1932- | ![]() |
Bushinsky, David A. | ![]() |
Kitzman, Delane W. | ![]() |
Ruschitzka, Frank | ![]() |
Metra, Marco | ![]() |
Filippatos, Gerasimos | ![]() |
Rossignol, Patrick | ![]() |
Du Mond, Charles | ![]() |
Garza, Dahlia | ![]() |
Berman, Lance | ![]() |
Lainščak, Mitja | 22680 |
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