Table 4. Summary of 3 clinical trials examining patiromer safety and efficacy.

Created using data from [106–108]

Study	Patients	Drug	Outcome	Adverse effect
PEARL-HF [106]	105 pts with CHF+CKD or prior discontinuation of RAAS blocker or beta blocker due to hyperkalemia	Spironolactome + patiromer or placebo, 4 weeks	Placebo: 25% K > 5.5 mEq/L Patiromer: 7% K > 5.5 mEq/L	24% of patiromer patients Mg < 1.8 mg/dL
OPAL-HK [107]	237 pts with CKD stages 3/4 on RAAS blockade	Patiromer, 8 weeks Dose adjustments required in 60% of patients, mostly on days 3 and 7	After drug withdrawal: Hyperkalemia in 90% in placebo group vs. 43% in patiromer group Able to continue RAAS blocker: 44% in placebo group vs. 94% in patiromer group	9 patients in patiromer group required Mg replacement
AMETHYST-DN [108]	306 pts with diabetic nephropathy on ACE-I/ARB + spironolactone	Patiromer, 1 year	Significant decrease in serum K+ throughout the study period	Hypomagnesemia; constipation; 30% of patients discontinued treatment

CHF, congestive heart failure. CKD, chronic kidney disease. RAAS blocker, renin-angiotensin-aldosterone system blocker. ACE-I, angiotensin converting enzyme inhibitor. ARB, angiotensin receptor blocker.