{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:27:07Z","timestamp":1788280027251,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","funder":[{"name":"Relypsa, Inc., a Vifor Pharma Group Company"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mineralocorticoid receptor antagonists reduce mortality in patients with heart failure with reduced ejection fraction and have become a standard of care in those with resistant hypertension (rHTN). Yet, their use is limited among patients with CKD, primarily due to hyperkalemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AMBER was a multicenter, randomized, double-blind, placebo-controlled, parallel-group study that reported that the use of the potassium-binding drug patiromer allowed a more persistent use of spironolactone in patients with CKD and rHTN. In this report, we compare the safety and efficacy of patiromer in advanced CKD as a prespecified analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 295 patients randomized, 66 fell into the eGFR 25 to &lt;30 subgroup. In this subgroup, persistent use of spironolactone was seen in 19 of 34 (56%) in the placebo group and 27 of 32 (84%) in the patiromer group (absolute difference 29%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.02). In the eGFR 30\u201345 subgroup, persistent use of spironolactone was seen in 79 of 114 (69%) in the placebo group and 99 of 115 (86%) in the patiromer group (absolute difference 17%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.003). There was no significant interaction between eGFR subgroups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.46). Systolic BP reduction with spironolactone in the eGFR 25 to &lt;30 subgroup was 6\u20137 mm Hg; in the eGFR 30\u201345 subgroup, it was 12\u201313 mm Hg. There was no significant interaction between eGFR subgroups on BP reduction (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.79). Similar proportions of patients reported adverse events (59% in the eGFR 25 to &lt;30 subgroup; 53% in the eGFR 30\u201345 subgroup).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Patiromer facilitates the use of spironolactone among patients with rHTN, and its efficacy and safety are comparable in those with eGFR 25 to &lt;30 and 30\u201345 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial registry name and registration number:<\/jats:title>\n                    <jats:p>Clinicaltrials.gov, NCT03071263<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0006782020","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T17:50:12Z","timestamp":1610733012000},"page":"425-434","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":21,"title":["Patiromer and Spironolactone in Resistant Hypertension and Advanced CKD: Analysis of the Randomized AMBER Trial"],"prefix":"10.34067","volume":"2","clinical-trial-number":[{"clinical-trial-number":"nct03071263","registry":"10.18810\/clinical-trials-gov","type":"results"},{"clinical-trial-number":"nct03888066","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03071263","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8355-7100","authenticated-orcid":false,"given":"Rajiv","family":"Agarwal","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"University of Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116 and FCRIN INI-CRCT, Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Budden","sequence":"additional","affiliation":[{"name":"Medical Affairs, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha R.","family":"Mayo","sequence":"additional","affiliation":[{"name":"Clinical Development, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Arthur","sequence":"additional","affiliation":[{"name":"Biostatistics, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Medicine, Institute of Cardiovascular Sciences University College London and National Institute for Health Research University College London\/University College London Hospitals Biomedical Research Centre, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William B.","family":"White","sequence":"additional","affiliation":[{"name":"Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"B1-20250825","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1136\/heartjnl-2018-313599","article-title":"Global prevalence of resistant hypertension: A meta-analysis of data from 3.2 million 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denervation","volume":"72","author":"Singh","year":"2018","journal-title":"Hypertension"}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0006782020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:02:10Z","timestamp":1786478530000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0006782020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0006782020","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]},"assertion":[{"value":"2020-11-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}