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Abstract: TH-PO604

Patiromer for Hyperkalemia Management in Patients Receiving Renin-Angiotensin-Aldosterone System Inhibitors for Heart Failure (DIAMOND): Prespecified Analysis of Patients With or Without Diabetes

Session Information

Category: Hypertension and CVD

  • 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials


  • Filippatos, Gerasimos, National and Kapodistrian University of Athens, Athens, Greece

Group or Team Name

  • On behalf of the DIAMOND Executive Committee

Renin–angiotensin–aldosterone system inhibitors (RAASis) are the cornerstone of treatment for heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease; hyperkalemia (HK) can result in suboptimal RAASi use. The DIAMOND trial showed that treatment with patiromer, a novel potassium binder, maintained lower serum potassium (sK+) vs placebo, and facilitated optimal RAASi therapy, including mineralocorticoid receptor antagonists (MRAs), in patients with HFrEF. This prespecified analysis of the trial assessed patient subgroups with or without diabetes.


Patients with HFrEF with current or history of HK entered a single-blinded run-in phase of up to 12 weeks in which patiromer and RAASis were optimized. Patients were then randomized (1:1) to receive either double-blind continued patiromer or placebo (patiromer withdrawal). The primary endpoint was the mean change in sK+ from baseline to the end of the trial. Secondary endpoints included sK+ >5.5 mEq/L, durable enablement of MRA at target dose, investigator-reported adverse events of HK, HK-related hard outcome endpoints, and a win ratio of novel RAASi use score based on the sequence of all-cause mortality, cardiovascular hospitalization, and RAASi use. This prespecified analysis was performed in patients with or without diabetes.


Of 1195 patients entering the run-in phase, 878 were randomized, of whom 356 (41%) had diabetes. Patiromer’s treatment effect vs placebo was consistent in patients both with and without diabetes (Figure).


Patiromer can effectively control sK+ and facilitate optimization of MRAs in patients with HFrEF irrespective of diabetes.


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