{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:59:58Z","timestamp":1785473998348,"version":"3.56.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":2916,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2018,1,25]],"date-time":"2018-01-25T00:00:00Z","timestamp":1516838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Relypsa, Inc., a Vifor Pharma Group Company"},{"name":"Relypsa, Inc., a Vifor Pharma Group Company"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Hyperkalaemia risk precludes optimal renin\u2013angiotensin\u2013aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a sodium-free, non-absorbed potassium (K+)-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16.4 g\/day) followed by individualized titration in preventing hyperkalaemia and hypokalaemia when initiating spironolactone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This open-label 8-week study enrolled 63 patients with CKD, serum K+ 4.3\u20135.1 mEq\/L, and chronic HF, who, based on investigator opinion, should receive spironolactone. Eligible patients started spironolactone 25 mg\/day and patiromer 16.8 g\/day (divided into two doses), with patiromer titrated to maintain serum K+ 4.0\u20135.1 mEq\/L. Mean (standard deviation) serum K+ was 4.78 (0.51) mEq\/L at baseline; weekly values were 4.48\u20134.70 mEq\/L during treatment. Serum K+ of 3.5\u20135.5 mEq\/L at the end of study treatment (primary endpoint) was achieved by 57 (90.5%) patients; 53 (84.1%) had serum K+ 4.0\u20135.1 mEq\/L. One patient (1.6%) developed hypokalaemia, and two patients (3.2%) developed hypomagnesaemia. Spironolactone was increased to 50 mg\/day in all patients; 43 (68%) patients required one or more patiromer dose titration. Adverse events (AEs) occurred in 36 (57.1%) patients, with a low rate of discontinuations [four (6.3%) patients]. The most common AE was mild to moderate abdominal discomfort [four (6.3%) patients].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this open-label study, patiromer 16.8 g\/day followed by individualized titration maintained serum K+ within the target range in the majority of patients with HF and CKD, all of whom were uptitrated to spironolactone 50 mg\/day, patiromer was well tolerated, with a low incidence of hyperkalaemia, hypokalaemia, and hypomagnesaemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12265","type":"journal-article","created":{"date-parts":[[2018,1,25]],"date-time":"2018-01-25T06:38:38Z","timestamp":1516862318000},"page":"257-266","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Evaluation of an Individualized Dose Titration Regimen of Patiromer to Prevent Hyperkalaemia in Patients with Heart Failure and Chronic Kidney Disease"],"prefix":"10.1093","volume":"5","author":[{"given":"Bertram","family":"Pitt","sequence":"first","affiliation":[{"name":"Department of Medicine, Cardiovascular Center, University of Michigan , Ann Arbor, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Bushinsky","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Rochester School of Medicine , Rochester, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalane W.","family":"Kitzman","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine , Winston-Salem, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Ruschitzka","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, University Heart Centre, University Hospital , Zurich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Cardiology Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"INSERM, Centre d'Investigations Cliniques-Plurith\u00e9matique 1433, UMR 1116 Universit\u00e9 de Lorraine, CHRU de Nancy, French-Clinical Research Infrastructure Network (F-CRIN) INI-CRCT , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Du Mond","sequence":"additional","affiliation":[{"name":"Biometrics, Relypsa, Inc., a Vifor Pharma Group Company , Redwood City, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahlia","family":"Garza","sequence":"additional","affiliation":[{"name":"Medical Affairs, Relypsa, Inc., a Vifor Pharma Group Company , Redwood City, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lance","family":"Berman","sequence":"additional","affiliation":[{"name":"Medical Affairs, Relypsa, Inc., a Vifor Pharma Group Company , Redwood City, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitja","family":"Lainscak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, General Hospital Murska Sobota and Faculty of Medicine, University of Ljubljana , Ljubljana ,","place":["Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,1,25]]},"reference":[{"key":"2026012115113734200_ehf212265-bib-0001","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure. 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