{"id":"d5e62144e44e","type":"article","url":"https://hartvaat.nl/2022/11/01/diamond-patiromer-maakt-raas-remmer-optitratie-bij-hfref-met-hyperkaliemie-mogel/","title":"DIAMOND: patiromer maakt RAAS-remmer-optitratie bij HFrEF met hyperkaliëmie mogelijk","title_en":"Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac401","source_url":"https://doi.org/10.1093/eurheartj/ehac401","authors":["Javed Butler","Stefan D Anker","Lars H Lund","Andrew J S Coats","Gerasimos Filippatos","Tariq Jamal Siddiqi","Tim Friede","Vincent Fabien","Mikhail Kosiborod","Marco Metra","Ileana L Piña","Fausto Pinto","Patrick Rossignol","Peter van der Meer","Cecilia Bahit","Jan Belohlavek","Michael Böhm","Jasper J Brugts","John G F Cleland","Justin Ezekowitz","Antoni Bayes-Genis","Israel Gotsman","Assen Goudev","Irakli Khintibidze","Joann Lindenfeld","Robert J Mentz","Bela Merkely","Eliodoro Castro Montes","Wilfried Mullens","Jose C Nicolau","Aleksandr Parkhomenko","Piotr Ponikowski","Petar M Seferovic","Michele Senni","Evgeny Shlyakhto","Alain Cohen-Solal","Peter Szecsödy","Klaus Jensen","Fabio Dorigotti","Matthew R Weir","Bertram Pitt"],"significance":8,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"The DIAMOND trial showed that patiromer effectively reduced serum potassium in patients with HFrEF, enabling more patients to reach target doses of RAAS inhibitors without hyperkalemia-related dose reductions. The results addressed a key barrier to optimal heart failure pharmacotherapy.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T13:29:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De DIAMOND-trial toonde dat patiromer de serumkaliumspiegel effectief verlaagde bij HFrEF-patiënten, waardoor RAAS-remmers op hogere doses konden worden gehandhaafd. Minder patiënten moesten hun RAAS-remmer dosisverlagen of staken. Kaliumbinders kunnen de hartfalenbehandeling optimaliseren.","abstract_original":"AIMS: To investigate the impact of patiromer on the serum potassium level and its ability to enable specified target doses of renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: A total of 1642 patients with HFrEF and current or a history of RAASi-related hyperkalemia were screened and 1195 were enrolled in the run-in phase with patiromer and optimization of the RAASi therapy [≥50% recommended dose of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, and 50 mg of mineralocorticoid receptor antagonist (MRA) spironolactone or eplerenone]. Specified target doses of the RAASi therapy were achieved in 878 (84.6%) patients; 439 were randomized to patiromer and 439 to placebo. All patients, physicians, and outcome assessors were blinded to treatment assignment. The primary endpoint was between-group difference in the adjusted mean change in serum potassium. Five hierarchical secondary endpoints were assessed. At the end of treatment, the median (interquartile range) duration of follow-up was 27 (13-43) weeks, the adjusted mean change in potassium was +0.03 mmol/l in the patiromer group and +0.13 mmol/l in the placebo group [difference in the adjusted mean change between patiromer and placebo: -0.10 mmol/l (95% confidence interval, CI -0.13, 0.07); P < 0.001]. Risk of hyperkalemia >5.5 mmol/l [hazard ratio (HR) 0.63; 95% CI 0.45, 0.87; P = 0.006), reduction of MRA dose (HR 0.62; 95% CI 0.45, 0.87; P = 0.006), and total adjusted hyperkalemia events/100 person-years (77.7 vs. 118.2; HR 0.66; 95% CI 0.53, 0.81; P < 0.001) were lower with patiromer. Hyperkalemia-related morbidity-adjusted events (win ratio 1.53, P < 0.001) and total RAASi use score (win ratio 1.25, P = 0.048) favored the patiromer arm. Adverse events were similar between groups. CONCLUSION: Concurrent use of patiromer and high-dose MRAs reduces the risk of recurrent hyperkalemia (ClinicalTrials.gov: NCT03888066)."}