DIAMOND (patiromer)
Trial question
What is the role of patiromer in patients with HFrEF and hyperkalemia?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
27.0% female
73.0% male
N = 878
878 patients (238 female, 640 male).
Inclusion criteria: patients with HFrEF and hyperkalemia or a history of hyperkalemia.
Key exclusion criteria: eGFR < 30 mL/min/1.73 m²; SBP < 90 mmHg or symptomatic hypotension; any significant comorbidity that could change their clinical course independent of HF.
Interventions
N=439 patiromer (titrated up to maximum 3 packs/day, 8.4 g/pack).
N=439 placebo (matching placebo).
Primary outcome
Mean change in serum potassium
0.03 mmol/L
0.13 mmol/L
0.1 mmol/L
0.1 mmol/L
0.1 mmol/L
0.0 mmol/L
0.0 mmol/L
Patiromer
Placebo
Significant
decrease ▼
Significant decrease in mean change in serum potassium (0.03 mmol/L vs. 0.13 mmol/L; AD -0.1 mmol/L, 95% CI -0.13 to -0.07).
Secondary outcomes
Significant decrease in patients with hyperkalemia > 5.5 mmol/L (13.9% vs. 19.4%; HR 0.63, 95% CI 0.45 to 0.87).
Significant decrease in patients with mineralocorticoid receptor antagonist reduction (13.9% vs. 18.9%; HR 0.62, 95% CI 0.45 to 0.87).
Significant decrease in the incidence of total hyperkalemia events (77.7/100 py vs. 118.2/100 py; HR 0.66, 95% CI 0.53 to 0.81).
Safety outcomes
No significant difference in adverse events.
Conclusion
In patients with HFrEF and hyperkalemia or a history of hyperkalemia, patiromer was superior to placebo with respect to mean change in serum potassium.
Reference
Javed Butler, Stefan D Anker, Lars H Lund et al. Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial. Eur Heart J. 2022 Nov 1;43(41):4362-4373.
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