Abstract: PO2369
A Comparison of the Efficacy of Patiromer Plus RAAS Inhibitor Therapy in Patients with CKD and Diabetes to a Cohort of Patients Not Using Patiromer: A Real-World Analysis Using Propensity Score Matching
Session Information
- CKD: Insights from Recent Clinical Trials and Large Real-World Effectiveness Studies
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Epstein, Murray, University of Miami School of Medicine, Miami, Florida, United States
- Budden, Jeffrey J., Vifor Pharma Group, Redwood City, California, United States
- Chinnadurai, Rajkumar, Salford Royal NHS Foundation Trust, Salford, Salford, United Kingdom
- Kalra, Philip A., Salford Royal NHS Foundation Trust, Salford, Salford, United Kingdom
Background
The AMETHYST-DN trial evaluated the use of patiromer (PAT) to treat hyperkalemia in patients (pts) with diabetes and CKD treated with RAASi. This analysis compared the progression of proteinuria and eGFR in AMETHYST-DN pts with a matched, real-world group of CKD pts with diabetes not receiving PAT.
Methods
Pts from AMETHYST-DN were closely matched with Salford Kidney Study (SKS) pts (a large CKD cohort in the United Kingdom). Matching was performed for age, gender, baseline systolic and diastolic blood pressure (BP), heart failure (HF) status, serum K+ and eGFR by propensity scores generated from a logistic regression analysis (1:1, nearest neighbour method). All pts were followed up for a median duration of 12 months. The median change in proteinuria and eGFR between baseline and 12-month follow-up were compared between groups.
Results
Out of 3564 pts recruited into the SKS from Oct 2002 to Dec 2019, 526 diabetic pts were eligible for matching with the 304 AMETHYST-DN pts. Propensity score matching yielded a well-matched cohort of 142:142 pts for the trend analysis. Median age was 68 yrs, 68% were male, median BP was 152/80 mmHg, and 27% had HF. Median eGFR was 32.5 mL/min/1.73m2 and uACR was 283 mg/g. RAASi use was 100% at baseline and 99% at follow-up in AMETHYST-DN pts. In contrast, RAASi use was 60% at baseline declining to 43% at 12-month follow-up in the SKS cohort. Trend analysis showed a significant difference in the rate of change in proteinuria at 12 months in AMETHYST-DN vs SKS pts (−31 mg/g vs +9 mg/g, p=0.023). No significant difference was observed for eGFR change (Table).
Conclusion
PAT enabled sustained RAASi use in 99% of pts in AMETHYST-DN, compared to 43% pts in a matched SKS cohort over 12 months. AMETHYST-DN pts had significantly reduced proteinuria at follow-up compared to SKS CKD pts, possibly due to continuation of RAASi enabled by PAT. No significant changes in eGFR were observed in either group.
Funding
- Commercial Support – Vifor Pharma