{"id":"825ed081fc97","type":"article","url":"https://hartvaat.nl/2024/10/01/patiromer-faciliteert-raas-remmer-optitratie-bij-hfref-met-hyperkaliemie/","title":"Patiromer faciliteert RAAS-remmer-optitratie bij HFrEF met hyperkaliëmie","title_en":"Patiromer Facilitates Angiotensin Inhibitor and Mineralocorticoid Antagonist Therapies in Patients With Heart Failure and Hyperkalemia.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.05.079","source_url":"https://doi.org/10.1016/j.jacc.2024.05.079","authors":["Bertram Pitt","Stefan D Anker","Lars H Lund","Andrew J S Coats","Gerasimos Filippatos","Patrick Rossignol","Matthew R Weir","Tim Friede","Mikhail N Kosiborod","Marco Metra","Michael Böhm","Justin A Ezekowitz","Antoni Bayes-Genis","Robert J Mentz","Piotr Ponikowski","Michele Senni","Ileana L Piña","Fausto J Pinto","Peter van der Meer","Cecilia Bahit","Jan Belohlavek","Jasper J Brugts","Amandine Perrin","Sandra Waechter","Jeffrey Budden","Javed Butler"],"significance":7,"published":"2024-10-01","source_date":"2024-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This study confirmed that patiromer enables optimization of RAAS inhibitor and MRA therapy in HFrEF patients with hyperkalemia, addressing the potassium barrier that limits guideline-directed heart failure treatment.","created":"2026-07-03T10:31:13Z","updated":"2026-07-03T13:30:15Z","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":"Studie bevestigde dat patiromer de RAAS-remmer- en MRA-therapie mogelijk maakt bij HFrEF-patiënten met hyperkaliëmie. Kaliumbinding is een effectieve strategie om hartfalenbehandeling te optimaliseren.","abstract_original":"BACKGROUND: Hyperkalemia (HK) is associated with suboptimal renin-angiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF). OBJECTIVES: This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase. METHODS: Patients with HFrEF and HK or past HK entered a run-in phase of ≤12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve ≥50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria). RESULTS: Of 1,038 patients completing the run-in, 878 (84.6%) were randomized and 160 (15.4%) were run-in failures. Overall, 422 (40.7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40.3% vs 42.5%; P = 0.605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76.8% to 98.6%; MRA: 35.9% to 98.6%) and past HK (RAS inhibitor: 60.5% to 98.1%; MRA: 15.6% to 98.7%). Despite not meeting the randomization criteria, an increase after run-in was observed in the run-in failure group in target RAS inhibitor (52.5% to 70.6%) and MRA use (15.0% to 48.1%). This increase was observed in patients with HK (RAS inhibitor: 51.5% to 64.7%; MRA: 19.1% to 39.7%) and past HK (RAS inhibitor: 53.3% to 75.0%; MRA: 12.0% to 54.3%). CONCLUSIONS: In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in."}