NCT01371747

Brief Summary

This study determined the optimal starting dose of patiromer in treating hyperkalemia in participants with hypertension and diabetic nephropathy who were already receiving ACEI and/or ARB drugs, with or without spironolactone. This study also evaluated the efficacy and safety of patiromer and the long term use of patiromer.

Trial Health

93
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
324

participants targeted

Target at P75+ for phase_2

Timeline
Completed

Started Jun 2011

Geographic Reach
5 countries

43 active sites

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

June 1, 2011

Completed
8 days until next milestone

First Submitted

Initial submission to the registry

June 9, 2011

Completed
4 days until next milestone

First Posted

Study publicly available on registry

June 13, 2011

Completed
1.9 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

May 1, 2013

Completed
1 month until next milestone

Study Completion

Last participant's last visit for all outcomes

June 1, 2013

Completed
2.5 years until next milestone

Results Posted

Study results publicly available

December 17, 2015

Completed
Last Updated

June 3, 2021

Status Verified

May 1, 2021

Enrollment Period

1.9 years

First QC Date

June 9, 2011

Results QC Date

November 11, 2015

Last Update Submit

May 10, 2021

Conditions

Keywords

HyperkalemiaChronic Kidney DiseaseTreatment of HyperkalemiaHypertensionDiabetic Nephropathy

Outcome Measures

Primary Outcomes (1)

  • Least Squares Mean Change in Serum Potassium From Baseline to Week 4 or Time of First Titration for Each Individual Starting Dose Group

    Least square mean changes from Baseline to Week 4/first titration were derived from parallel lines ANCOVA model with randomized starting dose and baseline serum potassium value as covariates.

    Baseline to Week 4 or First Titration which could occur at any scheduled study visit after patiromer initiation.

Secondary Outcomes (8)

  • Least Squares Mean Change in Serum Potassium From Baseline to Week 8 or Time of First Titration for Each Individual Starting Dose Group

    Baseline to Week 8 or First Titration which could occur at any scheduled study visit after patiromer initiation.

  • Least Squares Mean Change in Serum Potassium From Baseline to Day 3 During the Treatment Initiation Period for Each Individual Starting Dose Group

    Baseline to Day 3

  • Mean Change in Serum Potassium From Baseline to Week 52 During the Long-term Maintenance Period for Each Individual Starting Dose Group

    Baseline to Week 52

  • Mean Change in Serum Potassium From Week 52 or Last Patiromer Dose (if Occurred Before Week 52) to Follow-up Visits Plus 7 Days

    Week 52 or Last Patiromer Dose (if Occurred before Week 52) to Following up Visit Plus 7 Days

  • Proportion of Participants Achieving Serum Potassium Levels Within 3.5 to 5.5 mEq/L at Week 8 for Each Individual Starting Dose Group

    Baseline to Week 8

  • +3 more secondary outcomes

Study Arms (6)

Stratum 1: 8.4 g/d patiromer

EXPERIMENTAL

Participants with baseline serum potassium \> 5.0 to 5.5 mEq/L (milliequivalent)

Drug: patiromerDrug: losartanDrug: spironolactone

Stratum 1: 16.8 g/d patiromer

EXPERIMENTAL

Participants with baseline serum potassium \> 5.0 to 5.5 mEq/L

Drug: patiromerDrug: losartanDrug: spironolactone

Stratum 1: 25.2 g/d patiromer

EXPERIMENTAL

Participants with baseline serum potassium \> 5.0 to 5.5 mEq/L

Drug: patiromerDrug: losartanDrug: spironolactone

Stratum 2: 16.8 g/d patiromer

EXPERIMENTAL

Participants with baseline serum potassium \> 5.5 to \< 6.0 mEq/L

Drug: patiromerDrug: losartanDrug: spironolactone

Stratum 2: 25.2 g/d patiromer

EXPERIMENTAL

Participants with baseline serum potassium \> 5.5 to \< 6.0 mEq/L

Drug: patiromerDrug: losartanDrug: spironolactone

Stratum 2: 33.6 g/d patiromer

EXPERIMENTAL

Participants with baseline serum potassium \> 5.5 to \< 6.0 mEq/L

Drug: patiromerDrug: losartanDrug: spironolactone

Interventions

Cohorts 1, 2 and 3 - Patiromer starting dose: 8.4 g/day, orally, as a divided dose, twice daily. The dose of patiromer could be titrated based on participant's serum potassium response (Stratum 1)

Also known as: RLY5016 for Oral Suspension, Veltassa
Stratum 1: 8.4 g/d patiromer

losartan dose: 100 mg/d, oral, once daily (initiated during Run-In Period; Cohort 1)

Stratum 1: 16.8 g/d patiromerStratum 1: 25.2 g/d patiromerStratum 1: 8.4 g/d patiromerStratum 2: 16.8 g/d patiromerStratum 2: 25.2 g/d patiromerStratum 2: 33.6 g/d patiromer

Spironolactone dose: 25 mg/d or up to 50 mg/d, oral, once daily (initiated during Run-In Period; Cohort 2)

Stratum 1: 16.8 g/d patiromerStratum 1: 25.2 g/d patiromerStratum 1: 8.4 g/d patiromerStratum 2: 16.8 g/d patiromerStratum 2: 25.2 g/d patiromerStratum 2: 33.6 g/d patiromer

Eligibility Criteria

Age30 Years - 80 Years
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Age 30 - 80 years old at screening (S1)
  • Type 2 diabetes mellitus (T2DM) diagnosed after age 30 which has been treated with oral medications or insulin for at least 1 year prior to S1
  • Chronic kidney disease (CKD): estimated glomerular filtration rate (eGFR) 15 - \< 60 mL/min/1.73m2 at screening based on central lab serum creatinine measurement (except for participants with hyperkalemia at S1), whose eligibility will be assessed based on local lab eGFR value)
  • Urine albumin/creatinine ratio (ACR):
  • Cohorts 1 and 2: urine ACR ≥ 30 mg/g at S1 AND average urine ACR ≥ 30 mg/g at the beginning of Run-In Period (R0) based on up to three ACR values obtained starting at S1 and ending at the R0 Visit
  • Cohort 3: not applicable
  • Local laboratory serum potassium (K+) values of:
  • Cohorts 1 and 2: 4.3 - 5.0 mEq/L at S1; AND 4.5 - 5.0 mEq/L at R0; AND \> 5.0 - \< 6.0 mEq/L at randomization to patiromer (Baseline, T0 Visit)
  • Cohort 3: \> 5.0 - \< 6.0 mEq/L at S1 OR at R0 after same day confirmation
  • Must be receiving an ACEI and/or ARB for at least 28 days prior to screening
  • Average systolic blood pressure (SBP) ≥ 130 - \< 180 mmHg AND average DBP ≥ 80 - \< 110 mmHg (sitting) at both screening and R0 (as applicable)
  • Females of child-bearing potential must be non-lactating, must have a negative serum pregnancy test at screening, and must have used a highly effective form of contraception for at least 3 months before patiromer administration, during the study, and for one month after study completion
  • Provide their written informed consent prior to participation in the study

You may not qualify if:

  • Type 1 diabetes mellitus
  • Central lab hemoglobin A1c \> 12% at Screening 1 (S1) (except for Cohort 3 participants who are hyperkalemic at S1)
  • Emergency treatment for T2DM within the last 3 months
  • A confirmed SBP \> 180 mmHg or diastolic blood pressure (DBP) \> 110 mmHg at any time during SI or Run-In Period or at Baseline T0 Visit
  • Central lab serum magnesium \< 1.4 mg/dL (\< 0.58 mmol/L) at screening (Cohort 3 participants will be evaluated based on local lab serum magnesium measurement)
  • Central lab urine ACR ≥ 10000 mg/g at screening (except for Cohort 3 participants who are hyperkalemic at S1)
  • Confirmed diagnosis or history of renal artery stenosis (unilateral or bilateral)
  • Diabetic gastroparesis
  • Non-diabetic chronic kidney disease
  • History of bowel obstruction, swallowing disorders, severe gastrointestinal disorders or major gastrointestinal surgery (e.g., large bowel resection)
  • Current diagnosis of NYHA (New York Heart Association) Class III or IV heart failure
  • Body mass index (BMI) ≥ 40 kg/m2
  • Any of the following events having occurred within 2 months prior to screening: unstable angina as judged by the Principal Investigator (PI), unresolved acute coronary syndrome, cardiac arrest or clinically significant ventricular arrhythmias, transient ischemic attack or stroke, use of any intravenous cardiac medication
  • Prior kidney transplant, or anticipated need for transplant during study participation
  • Active cancer, currently on cancer treatment or history of cancer in the past 2 years except for non-melanocytic skin cancer which is considered cured
  • +9 more criteria

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (43)

Investigator Site 201

Karlovac, 47000, Croatia

Location

Investigator Site 207

Osijek, 31000, Croatia

Location

Investigator Site 203

Rijeka, 51000, Croatia

Location

Investigator Site 202

Zagreb, 10000, Croatia

Location

Investigator Site 204

Zagreb, 10000, Croatia

Location

Investigator Site 208

Zagreb, 10000, Croatia

Location

Investigator Site 305

Tbilisi, 0102, Georgia

Location

Investigator Site 309

Tbilisi, 0144, Georgia

Location

Investigator site 301

Tbilisi, 0159, Georgia

Location

Investigator Site 302

Tbilisi, 0159, Georgia

Location

Investigator Site 303

Tbilisi, 0159, Georgia

Location

Investigator Site 304

Tbilisi, 0159, Georgia

Location

Investigator Site 306

Tbilisi, 0159, Georgia

Location

Investigator Site 307

Tbilisi, 0159, Georgia

Location

Investigator Site 310

Tbilisi, 0159, Georgia

Location

Investigator Site 311

Tbilisi, 0159, Georgia

Location

Investigator Site 308

Tbilisi, 0186, Georgia

Location

Investigator Site 508

Budapest, 1097, Hungary

Location

Investigator Site 502

Budapest, 1106, Hungary

Location

Investigator Site 514

Budapest, H-1041, Hungary

Location

Investigator Site 513

Budapest, H-1097, Hungary

Location

Investigator Site 517

Budapest, H-1115, Hungary

Location

Investigator Site 522

Győr, H-9024, Hungary

Location

Investigator Site 523

Hatvan, 3000, Hungary

Location

Investigator Site 515

Jászberény, H-5100, Hungary

Location

Investigator Site 506

Kistarcsa, H-2143, Hungary

Location

Investigator Site 503

Kisvárda, 4600, Hungary

Location

Investigator Site 510

Mosonmagyaróvár, H-9200, Hungary

Location

Investigator Site 504

Székesfehérvár, H-8000, Hungary

Location

Investigator Site 505

Szikszó, 3800, Hungary

Location

Investigator Site 507

Veszprém, H-8200, Hungary

Location

Investigator Site 601

Belgrade, 11000, Serbia

Location

Investigator Site 602

Belgrade, 11000, Serbia

Location

Investigator Site 604

Belgrade, 11000, Serbia

Location

Investigator Site 605

Belgrade, 11000, Serbia

Location

Investigator Site 603

Novi Sad, 21000, Serbia

Location

Investigator Site 607

Zrenjanin, 23000, Serbia

Location

Investigator Site 703

Celje, 3000, Slovenia

Location

Investigator Site 706

Golnik, 4204, Slovenia

Location

Investigator Site 708

Jesenice, 4270, Slovenia

Location

Investigator Site 701

Maribor, 2000, Slovenia

Location

Investigator Site 704

Slovenj Gradec, 2380, Slovenia

Location

Investigator Site 707

Šempeter pri Gorici, 5290, Slovenia

Location

Related Publications (4)

  • Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, Stasiv Y, Zawadzki R, Berman L, Bushinsky DA; AMETHYST-DN Investigators. Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease: The AMETHYST-DN Randomized Clinical Trial. JAMA. 2015 Jul 14;314(2):151-61. doi: 10.1001/jama.2015.7446.

    PMID: 26172895BACKGROUND
  • Bakris GL, Woods SD, Alvarez PJ, Arthur SP, Kumar R. Hyperkalemia Management in Older Adults With Diabetic Kidney Disease Receiving Renin-Angiotensin-Aldosterone System Inhibitors: A Post Hoc Analysis of the AMETHYST-DN Clinical Trial. Kidney Med. 2021 Mar 13;3(3):360-367.e1. doi: 10.1016/j.xkme.2021.01.005. eCollection 2021 May-Jun.

  • Natale P, Palmer SC, Ruospo M, Saglimbene VM, Strippoli GF. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease. Cochrane Database Syst Rev. 2020 Jun 26;6(6):CD013165. doi: 10.1002/14651858.CD013165.pub2.

  • Pitt B, Bakris GL, Weir MR, Freeman MW, Lainscak M, Mayo MR, Garza D, Zawadzki R, Berman L, Bushinsky DA. 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. ESC Heart Fail. 2018 Aug;5(4):592-602. doi: 10.1002/ehf2.12292. Epub 2018 May 16.

MeSH Terms

Conditions

Renal Insufficiency, ChronicHypertensionHyperkalemiaDiabetic Nephropathies

Interventions

patiromerSuspensionsLosartanSpironolactone

Condition Hierarchy (Ancestors)

Renal InsufficiencyKidney DiseasesUrologic DiseasesFemale Urogenital DiseasesFemale Urogenital Diseases and Pregnancy ComplicationsUrogenital DiseasesMale Urogenital DiseasesChronic DiseaseDisease AttributesPathologic ProcessesPathological Conditions, Signs and SymptomsVascular DiseasesCardiovascular DiseasesWater-Electrolyte ImbalanceMetabolic DiseasesNutritional and Metabolic DiseasesDiabetes ComplicationsDiabetes MellitusEndocrine System Diseases

Intervention Hierarchy (Ancestors)

ColloidsComplex MixturesDosage FormsPharmaceutical PreparationsBiphenyl CompoundsBenzene DerivativesHydrocarbons, AromaticHydrocarbons, CyclicHydrocarbonsOrganic ChemicalsImidazolesAzolesHeterocyclic Compounds, 1-RingHeterocyclic CompoundsTetrazolesLactonesPregnenesPregnanesSteroidsFused-Ring CompoundsPolycyclic Compounds

Results Point of Contact

Title
Medical Information
Organization
Relypsa, Inc.

Study Officials

  • Director Clinical Operations

    Relypsa, Inc.

    STUDY DIRECTOR

Publication Agreements

PI is Sponsor Employee
No
Restriction Type
OTHER
Restrictive Agreement
Yes

Study Design

Study Type
interventional
Phase
phase 2
Allocation
RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
INDUSTRY
Responsible Party
SPONSOR

Study Record Dates

First Submitted

June 9, 2011

First Posted

June 13, 2011

Study Start

June 1, 2011

Primary Completion

May 1, 2013

Study Completion

June 1, 2013

Last Updated

June 3, 2021

Results First Posted

December 17, 2015

Record last verified: 2021-05

Locations