- Question
- Can patiromer control serum potassium and allow target doses of renin-angiotensin-aldosterone system (RAAS) inhibitors to be maintained in patients with heart failure with reduced ejection fraction (HFrEF) and a history of hyperkalemia?
- Design
- Multicenter, double-blind, placebo-controlled, randomized-withdrawal phase 3 trial. After an open-label run-in with patiromer and therapy optimization, 878 patients were randomized 1:1 (439 per group); median follow-up was 27 weeks.
- Population
- Patients with HFrEF and current or prior RAAS inhibitor-related hyperkalemia who reached specified target doses of ACE inhibitor/ARB/ARNI and a mineralocorticoid receptor antagonist (MRA) during the run-in.
- Intervention
- Once-daily patiromer, with dose adjustments based on serum potassium, on top of optimized RAAS inhibitor therapy.
- Control
- Once-daily placebo, with dose adjustments based on serum potassium, on top of the same optimized RAAS inhibitor therapy.
- Primary outcome
- Between-group difference in the adjusted mean change in serum potassium from baseline to the end of treatment.
- Results
- Potassium rose by +0.03 mmol/l with patiromer and +0.13 mmol/l with placebo (difference -0.10 mmol/l; P < 0.001). Patiromer reduced the risk of hyperkalemia >5.5 mmol/l (HR 0.63; 95% CI 0.45-0.87; P = 0.006).
- Safety
- Adverse events were similar between groups.
- Conclusion
- Concurrent use of patiromer and high-dose MRAs reduced the risk of recurrent hyperkalemia in patients with HFrEF.
- Why it matters
- It suggested that managing potassium with a binder can help sustain neurohormonal therapy in heart failure patients with prior hyperkalemia, who would otherwise often need these drugs reduced or stopped.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026