Patiromer in the Treatment of Hyperkalemia in Patients With Hypertension and Diabetic Nephropathy (AMETHYST-DN)
AMETHYST-DN
A Multicenter, Randomized, Open-Label, Dose Ranging Study to Evaluate the Efficacy and Safety of Patiromer in the Treatment of Hyperkalemia in Patients With Hypertension and Diabetic Nephropathy Receiving Angiotensin-converting Enzyme Inhibitor (ACEI) and/or Angiotensin II Receptor Blocker (ARB) Drugs, With or Without Spironolactone
2 other identifiers
interventional
324
5 countries
43
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
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for phase_2
Started Jun 2011
43 active sites
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
CompletedFirst Submitted
Initial submission to the registry
June 9, 2011
CompletedFirst Posted
Study publicly available on registry
June 13, 2011
CompletedPrimary Completion
Last participant's last visit for primary outcome
May 1, 2013
CompletedStudy Completion
Last participant's last visit for all outcomes
June 1, 2013
CompletedResults Posted
Study results publicly available
December 17, 2015
CompletedJune 3, 2021
May 1, 2021
1.9 years
June 9, 2011
November 11, 2015
May 10, 2021
Conditions
Keywords
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
EXPERIMENTALParticipants with baseline serum potassium \> 5.0 to 5.5 mEq/L (milliequivalent)
Stratum 1: 16.8 g/d patiromer
EXPERIMENTALParticipants with baseline serum potassium \> 5.0 to 5.5 mEq/L
Stratum 1: 25.2 g/d patiromer
EXPERIMENTALParticipants with baseline serum potassium \> 5.0 to 5.5 mEq/L
Stratum 2: 16.8 g/d patiromer
EXPERIMENTALParticipants with baseline serum potassium \> 5.5 to \< 6.0 mEq/L
Stratum 2: 25.2 g/d patiromer
EXPERIMENTALParticipants with baseline serum potassium \> 5.5 to \< 6.0 mEq/L
Stratum 2: 33.6 g/d patiromer
EXPERIMENTALParticipants with baseline serum potassium \> 5.5 to \< 6.0 mEq/L
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)
losartan dose: 100 mg/d, oral, once daily (initiated during Run-In Period; Cohort 1)
Spironolactone dose: 25 mg/d or up to 50 mg/d, oral, once daily (initiated during Run-In Period; Cohort 2)
Eligibility Criteria
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
- Relypsa, Inc.lead
Study Sites (43)
Investigator Site 201
Karlovac, 47000, Croatia
Investigator Site 207
Osijek, 31000, Croatia
Investigator Site 203
Rijeka, 51000, Croatia
Investigator Site 202
Zagreb, 10000, Croatia
Investigator Site 204
Zagreb, 10000, Croatia
Investigator Site 208
Zagreb, 10000, Croatia
Investigator Site 305
Tbilisi, 0102, Georgia
Investigator Site 309
Tbilisi, 0144, Georgia
Investigator site 301
Tbilisi, 0159, Georgia
Investigator Site 302
Tbilisi, 0159, Georgia
Investigator Site 303
Tbilisi, 0159, Georgia
Investigator Site 304
Tbilisi, 0159, Georgia
Investigator Site 306
Tbilisi, 0159, Georgia
Investigator Site 307
Tbilisi, 0159, Georgia
Investigator Site 310
Tbilisi, 0159, Georgia
Investigator Site 311
Tbilisi, 0159, Georgia
Investigator Site 308
Tbilisi, 0186, Georgia
Investigator Site 508
Budapest, 1097, Hungary
Investigator Site 502
Budapest, 1106, Hungary
Investigator Site 514
Budapest, H-1041, Hungary
Investigator Site 513
Budapest, H-1097, Hungary
Investigator Site 517
Budapest, H-1115, Hungary
Investigator Site 522
Győr, H-9024, Hungary
Investigator Site 523
Hatvan, 3000, Hungary
Investigator Site 515
Jászberény, H-5100, Hungary
Investigator Site 506
Kistarcsa, H-2143, Hungary
Investigator Site 503
Kisvárda, 4600, Hungary
Investigator Site 510
Mosonmagyaróvár, H-9200, Hungary
Investigator Site 504
Székesfehérvár, H-8000, Hungary
Investigator Site 505
Szikszó, 3800, Hungary
Investigator Site 507
Veszprém, H-8200, Hungary
Investigator Site 601
Belgrade, 11000, Serbia
Investigator Site 602
Belgrade, 11000, Serbia
Investigator Site 604
Belgrade, 11000, Serbia
Investigator Site 605
Belgrade, 11000, Serbia
Investigator Site 603
Novi Sad, 21000, Serbia
Investigator Site 607
Zrenjanin, 23000, Serbia
Investigator Site 703
Celje, 3000, Slovenia
Investigator Site 706
Golnik, 4204, Slovenia
Investigator Site 708
Jesenice, 4270, Slovenia
Investigator Site 701
Maribor, 2000, Slovenia
Investigator Site 704
Slovenj Gradec, 2380, Slovenia
Investigator Site 707
Šempeter pri Gorici, 5290, Slovenia
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: 26172895BACKGROUNDBakris 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.
PMID: 34136782DERIVEDNatale 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.
PMID: 32588430DERIVEDPitt 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.
PMID: 29767459DERIVED
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Results Point of Contact
- Title
- Medical Information
- Organization
- Relypsa, Inc.
Study Officials
- STUDY DIRECTOR
Director Clinical Operations
Relypsa, Inc.
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