Abstract P602: Patiromer Decreased Aldosterone, Urine Albumin/Creatinine Ratio, and Blood Pressure in Patients with Chronic Kidney Disease and Hyperkalemia on RAAS Inhibitors: Results from OPAL-HK
Introduction: Elevated aldosterone (ALD) is associated with chronic kidney disease (CKD) and cardiovascular (CV) complications. Patiromer, a nonabsorbed potassium (K+)-binding polymer, decreases serum K+ (sK+) and may allow increased use of RAAS inhibitors (RAASi) in patients (pts) with CKD and hyperkalemia (HK). This analysis examined the effect of patiromer on ALD, urinary albumin/creatinine ratio (ACR), and blood pressure (BP) in pts with CKD on RAASi.
Methods: OPAL-HK was a 2-part, phase 3 study in 243 CKD pts with sK+ 5.1–<6.5 mEq/L on RAASi. Pts received patiromer for 4 wks (Part A); pts with moderate-severe HK at baseline (sK+ ≥5.5 mEq/L) and sK+ 3.8–<5.1 at Part A wk 4 continued on patiromer (n=55) or switched to placebo (n=52) in the 8-wk withdrawal phase (Part B). RAASi were stable prior to and during Part A. Changes in ALD, ACR, and systolic BP/diastolic BP (SBP/DBP) were analyzed.
Results: After 4 wks of patiromer sK+, serum ALD and urine ALD/creatinine decreased, while plasma renin activity (PRA) was unchanged; SBP, DBP, and ACR also declined (Table). Mean±SE changes (ng/dL) in serum ALD from Part A wk 4 to Part B wk 4 and to Part B wk 8 were 4.6±1.6 (p<0.01) and 5.7±1.8 (p<0.01) in the placebo and 0.9±1.0 (p=NS) and 0.2±0.8 (p=NS) in the patiromer groups, respectively. Compared with Part A wk 4, SBP (mm Hg) was further reduced at Part B wk 4 (3.1±2.1, p=NS) and Part B wk 8 (5.4±1.9, p<0.01) with maintained improvement in ACR in patiromer pts.
Conclusions: Patiromer reduced both sK+ and ALD (independent of PRA) in CKD pts with HK on RAASi. ALD reductions correlated with lower BP and ACR. Reduction in sK+ may have lowered ALD possibly improving BP and ACR.
Author Disclosures: M. Weir: E. Honoraria; Modest; Amgen, Daiichi Sankyo, SanofiAventis, Relypsa, Janssen, Otsuka, Keryx, Akebia, MSD, Sandoz, Lexicon, AstraZeneca. G. Consultant/Advisory Board; Modest; Amgen, Daiichi Sankyo, SanofiAventis, Janssen, Relypsa, Otsuka, Keryx, Sandoz, Lexicon, AstraZeneca. G. Bakris: G. Consultant/Advisory Board; Modest; Relypsa, Janssen, Medtronic, AbbVie, Takeda, Bayer. C. Gross: None. M. Mayo: A. Employment; Significant; Relypsa. D. Garza: A. Employment; Significant; Relypsa. Y. Stasiv: A. Employment; Significant; Relypsa. J. Yuan: A. Employment; Significant; Relypsa. L. Berman: A. Employment; Significant; Relypsa. G. Williams: G. Consultant/Advisory Board; Modest; Relypsa, Pfizer International.
- © 2015 by American Heart Association, Inc.