{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:40:28Z","timestamp":1791319228329,"version":"4.3.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":2805,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2018,5,16]],"date-time":"2018-05-16T00:00:00Z","timestamp":1526428800000},"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":[[2018,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) in heart failure (HF) increases the risk of hyperkalaemia (HK), limiting angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) use. Patiromer is a sodium-free, non-absorbed potassium binder approved for HK treatment. We retrospectively evaluated patiromer's long-term safety and efficacy in HF patients from AMETHYST-DN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients with Type 2 diabetes, CKD, and HK [baseline serum potassium &amp;gt;5.0\u20135.5 mmol\/L (mild) or &amp;gt;5.5\u2013&amp;lt;6.0 mmol\/L (moderate)], with or without HF (New York Heart Association Class I and II, by investigator judgement), on ACE-I\/ARB, were randomized to patiromer 8.4\u201333.6 g to start, divided twice daily. Overall, 105\/304 (35%) patients had HF (75%, Class II). Mean (standard deviation) ejection fraction (EF) was 44.9% (8.2) (n = 81) in patients with HF; 26 had EF \u226440%. In HF patients, mean serum potassium decreased by Day 3 through Week 52. At Week 4, estimated mean (95% confidence interval) change in serum potassium was \u22120.64 mmol\/L (\u22120.72, \u22120.55) in mild and \u22120.97 mmol\/L (\u22121.14, \u22120.80) in moderate HK (both P &amp;lt; 0.0001). Most HF patients with mild (&amp;gt;88%) and moderate (\u226573%) HK had normokalaemia at each visit from Weeks 12 to 52. Three HF patients were withdrawn because of high (n = 1) or low (n = 2) serum potassium. The most common patiromer-related adverse event was hypomagnesaemia (8.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with a clinical diagnosis of HF, diabetes, CKD, and HK on ACE-I\/ARB, patiromer was well tolerated and effective for HK treatment over 52 weeks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12292","type":"journal-article","created":{"date-parts":[[2018,5,16]],"date-time":"2018-05-16T05:05:49Z","timestamp":1526447149000},"page":"592-602","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Long-Term Effects of Patiromer for Hyperkalaemia Treatment in Patients with Mild Heart Failure and Diabetic Nephropathy on Angiotensin-Converting Enzymes\/Angiotensin Receptor Blockers: Results from AMETHYST-DN"],"prefix":"10.1093","volume":"5","author":[{"given":"Bertram","family":"Pitt","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Michigan School of Medicine , Ann Arbor, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George L.","family":"Bakris","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Chicago Medicine , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Weir","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Maryland School of Medicine , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mason W.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Massachusetts General Hospital, Harvard University , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitja","family":"Lainscak","sequence":"additional","affiliation":[{"name":"Division of Cardiology, General Hospital Murska Sobota , Murska Sobota ,","place":["Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha R.","family":"Mayo","sequence":"additional","affiliation":[{"name":"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":"Relypsa, Inc., a Vifor Pharma Group Company , Redwood City, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rezi","family":"Zawadzki","sequence":"additional","affiliation":[{"name":"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":"Relypsa, Inc., a Vifor Pharma Group Company , Redwood City, CA ,","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"}]}],"member":"286","published-online":{"date-parts":[[2018,5,16]]},"reference":[{"key":"2026012115112581900_ehf212292-bib-0001","first-page":"659","article-title":"2016 ACC\/AHA\/HFSA focused update on new pharmacological therapy for heart failure: An update of the 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America","volume":"22","author":"Yancy","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2026012115112581900_ehf212292-bib-0002","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"18","author":"Ponikowski","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026012115112581900_ehf212292-bib-0003","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction","volume":"348","author":"Pitt","year":"2003","journal-title":"N Engl J Med"},{"key":"2026012115112581900_ehf212292-bib-0004","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. Randomized Aldactone Evaluation Study Investigators","volume":"341","author":"Pitt","year":"1999","journal-title":"N Engl J Med"},{"key":"2026012115112581900_ehf212292-bib-0005","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms","volume":"364","author":"Zannad","year":"2011","journal-title":"N Engl J Med"},{"key":"2026012115112581900_ehf212292-bib-0006","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s11096-013-9830-8","article-title":"Evaluation of the concurrent use of potassium-influencing drugs as risk factors for the development of hyperkalemia","volume":"35","author":"Kuijvenhoven","year":"2013","journal-title":"Int J Clin Pharm"},{"key":"2026012115112581900_ehf212292-bib-0007","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1016\/j.amjcard.2012.01.367","article-title":"Predictors of hyperkalemia and death in patients with cardiac and renal disease","volume":"109","author":"Jain","year":"2012","journal-title":"Am J Cardiol"},{"key":"2026012115112581900_ehf212292-bib-0008","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1001\/archinternmed.2009.132","article-title":"The frequency of hyperkalemia and its significance in chronic kidney disease","volume":"169","author":"Einhorn","year":"2009","journal-title":"Arch Intern Med"},{"key":"2026012115112581900_ehf212292-bib-0009","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1161\/HYPERTENSIONAHA.115.04889","article-title":"New potassium binders for the treatment of hyperkalemia: current data and opportunities for the future","volume":"66","author":"Pitt","year":"2015","journal-title":"Hypertension"},{"key":"2026012115112581900_ehf212292-bib-0010","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1056\/NEJMra035279","article-title":"Managing hyperkalemia caused by inhibitors of the renin\u2013angiotensin\u2013aldosterone system","volume":"351","author":"Palmer","year":"2004","journal-title":"N Engl J Med"},{"key":"2026012115112581900_ehf212292-bib-0011","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1001\/jama.2009.1493","article-title":"Use of aldosterone antagonists in heart failure","volume":"302","author":"Albert","year":"2009","journal-title":"JAMA"},{"key":"2026012115112581900_ehf212292-bib-0012","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1046\/j.1525-1497.1997.07128.x","article-title":"Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis","volume":"12","author":"Perazella","year":"1997","journal-title":"J Gen Intern Med"},{"key":"2026012115112581900_ehf212292-bib-0013","doi-asserted-by":"crossref","first-page":"f360","DOI":"10.1136\/bmj.f360","article-title":"Efficacy and safety of dual blockade of the renin\u2013angiotensin system: meta-analysis of randomised trials","volume":"346","author":"Makani","year":"2013","journal-title":"BMJ"},{"key":"2026012115112581900_ehf212292-bib-0014","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1080\/14656566.2016.1190333","article-title":"Recent advances in pharmacological treatments of hyperkalemia: focus on patiromer","volume":"17","author":"Epstein","year":"2016","journal-title":"Expert Opin Pharmacother"},{"key":"2026012115112581900_ehf212292-bib-0015","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1177\/1074248416629549","article-title":"Mechanism of action and pharmacology of patiromer, a nonabsorbed cross-linked polymer that lowers serum potassium concentration in patients with hyperkalemia","volume":"21","author":"Li","year":"2016","journal-title":"J Cardiovasc Pharmacol Ther"},{"key":"2026012115112581900_ehf212292-bib-0016","volume-title":"Veltassa (patiromer) for oral suspension [package insert]","year":"2016"},{"key":"2026012115112581900_ehf212292-bib-0017","volume-title":"Veltassa","author":"European Medicines Agency"},{"key":"2026012115112581900_ehf212292-bib-0018","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/ejhf.402","article-title":"Effect of patiromer on reducing serum potassium and preventing recurrent hyperkalaemia in patients with heart failure and chronic kidney disease on RAAS inhibitors","volume":"17","author":"Pitt","year":"2015","journal-title":"Eur J Heart Fail"},{"key":"2026012115112581900_ehf212292-bib-0019","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1038\/ki.2015.270","article-title":"Patiromer induces rapid and sustained potassium lowering in patients with chronic kidney disease and hyperkalemia","volume":"88","author":"Bushinsky","year":"2015","journal-title":"Kidney Int"},{"key":"2026012115112581900_ehf212292-bib-0020","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1093\/eurheartj\/ehq502","article-title":"Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial","volume":"32","author":"Pitt","year":"2011","journal-title":"Eur Heart J"},{"key":"2026012115112581900_ehf212292-bib-0021","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1001\/jama.2015.7446","article-title":"Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease: the AMETHYST-DN randomized clinical trial","volume":"314","author":"Bakris","year":"2015","journal-title":"JAMA"},{"key":"2026012115112581900_ehf212292-bib-0022","volume-title":"Guideline for good clinical practice E6","author":"ICH Harmonised Tripartite Guideline","year":"1996"},{"key":"2026012115112581900_ehf212292-bib-0023","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"Ethical principles for medical research involving human subjects","volume":"310","author":"World Medical Association Declaration of Helsinki","year":"2013","journal-title":"JAMA"},{"key":"2026012115112581900_ehf212292-bib-0024","volume-title":"Directive 2001\/20\/EC of the European Parliament and of the Council","year":"2001"},{"key":"2026012115112581900_ehf212292-bib-0025","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1056\/NEJMoa1410853","article-title":"Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors","volume":"372","author":"Weir","year":"2015","journal-title":"N Engl J Med"},{"key":"2026012115112581900_ehf212292-bib-0026","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.2215\/CJN.01170216","article-title":"Effect of patiromer on urinary ion excretion in healthy adults","volume":"11","author":"Bushinsky","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026012115112581900_ehf212292-bib-0027","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.kint.2016.04.019","article-title":"Treatment with patiromer decreases aldosterone in patients with chronic kidney disease and hyperkalemia on renin\u2013angiotensin system inhibitors","volume":"90","author":"Weir","year":"2016","journal-title":"Kidney Int"},{"key":"2026012115112581900_ehf212292-bib-0028","first-page":"201A","article-title":"Aldosterone, renin and blood pressure during patiromer treatment of hyperkalemia in CKD","volume":"17","author":"Weir","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"2026012115112581900_ehf212292-bib-0029","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1056\/NEJM199108013250501","article-title":"Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure","volume":"325","author":"The SOLVD Investigators","year":"1991","journal-title":"N Engl J Med"},{"key":"2026012115112581900_ehf212292-bib-0030","first-page":"S212","article-title":"Evaluation of the treatment gap between clinical guidelines and the utilization of renin\u2013angiotensin\u2013aldosterone system inhibitors","volume":"21","author":"Epstein","year":"2015","journal-title":"Am J Manag Care"},{"key":"2026012115112581900_ehf212292-bib-0031","first-page":"S313","article-title":"Evaluation of clinical outcomes and costs based on prescribed dose level of renin\u2013angiotensin\u2013aldosterone system inhibitors","volume":"22","author":"Epstein","year":"2016","journal-title":"Am J Manag Care"},{"key":"2026012115112581900_ehf212292-bib-0032","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/clc.20987","article-title":"Secondary prevention of hyperkalemia with sodium polystyrene sulfonate in cardiac and kidney patients on renin\u2013angiotensin\u2013aldosterone system inhibition therapy","volume":"35","author":"Chernin","year":"2012","journal-title":"Clin Cardiol"},{"key":"2026012115112581900_ehf212292-bib-0033","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5414\/CN108628","article-title":"Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective study","volume":"85","author":"Hagan","year":"2016","journal-title":"Clin Nephrol"},{"key":"2026012115112581900_ehf212292-bib-0034","doi-asserted-by":"crossref","DOI":"10.1016\/j.amjmed.2012.08.016","article-title":"Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review","volume":"126","author":"Harel","year":"2013","journal-title":"Am J Med"},{"key":"2026012115112581900_ehf212292-bib-0035","volume-title":"Kayexalate (Sodium Polystyrene Sulfonate) Cation-Exchange Resin [Prescribing Information]","year":"2010"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fehf2.12292","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/5\/4\/592\/66137048\/eschf_5_4_592.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/5\/4\/592\/66137048\/eschf_5_4_592.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T20:15:07Z","timestamp":1769026507000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/5\/4\/592\/8403778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,16]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,5,16]]},"published-print":{"date-parts":[[2018,8,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.12292","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,8]]},"published":{"date-parts":[[2018,5,16]]},"assertion":[{"value":"2017-09-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}