Changes in natriuretic peptide levels following patiromer-enabled optimization of medical therapy in heart failure: A post hoc analysis of the DIAMOND study

Andreas P Kalogeropoulos¹, Ishaque Hameed², Stefan D Anker³, Antoni Bayes-Genis⁴, Michael Böhm⁵, Jeffrey Budden⁶, John G F Cleland⁷, Andrew J S Coats⁸, Justin A Ezekowitz⁹, Gerasimos Filippatos¹⁰, Assen Goudev¹¹, Muhammad Shahzeb Khan^{12

13

14}, Joann Lindenfeld¹⁵, Lars H Lund¹⁶, Bela Merkely¹⁷, Robert J Mentz¹⁸, Marco Metra¹⁹, Jude Moutchia¹⁴, Amandine Perrin²⁰, Piotr Ponikowski²¹, Elisa L Priest¹⁴, Patrick Rossignol^{22

23}, Michele Senni²⁴, Courtney Shaver¹⁴, Sandra Waechter²⁰, Matthew R Weir²⁵, Bertram Pitt²⁶, Javed Butler¹⁴

Affiliations

¹ Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
² Department of Medicine, Medstar Health, Baltimore, MD, USA.
³ Department of Cardiology (CVK) of German Heart Center Charité, Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany.
⁴ Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Badalona, Spain.
⁵ Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.
⁶ CSL Vifor, Redwood City, CA, USA.
⁷ Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
⁸ Heart Research Institute, Sydney, NSW, Australia.
⁹ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
¹⁰ National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece.
¹¹ Department of Emergency Medicine, Medical University of Sofia, Sofia, Bulgaria.
¹² Department of Medicine, Baylor College of Medicine, Temple, TX, USA.
¹³ Division of Cardiology, The Heart Hospital Plano, Plano, TX, USA.
¹⁴ Baylor, Scott & White Research Institute, Dallas, TX, USA.
¹⁵ Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN, USA.
¹⁶ Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
¹⁷ Semmelweis University Heart and Vascular Center, Budapest, Hungary.
¹⁸ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹⁹ ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
²⁰ CSL Vifor, Glattbrugg, Switzerland.
²¹ Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
²² Université de Lorraine, Centre d'Investigations Cliniques-Plurithématique 14-33, Inserm U1116, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
²³ Medical Specialties and Nephrology Department, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, and M-CRIN, Monaco, Monaco.
²⁴ University of Milano-Bicocca, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
²⁵ Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
²⁶ Division of Cardiology, University of Michigan, Ann Arbor, MI, USA.

PMID: 40607983
DOI: 10.1002/ejhf.3754

Changes in natriuretic peptide levels following patiromer-enabled optimization of medical therapy in heart failure: A post hoc analysis of the DIAMOND study

Andreas P Kalogeropoulos et al. Eur J Heart Fail. 2025.

. 2025 Jul 3.

doi: 10.1002/ejhf.3754. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
² Department of Medicine, Medstar Health, Baltimore, MD, USA.
³ Department of Cardiology (CVK) of German Heart Center Charité, Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany.
⁴ Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Badalona, Spain.
⁵ Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.
⁶ CSL Vifor, Redwood City, CA, USA.
⁷ Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
⁸ Heart Research Institute, Sydney, NSW, Australia.
⁹ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
¹⁰ National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece.
¹¹ Department of Emergency Medicine, Medical University of Sofia, Sofia, Bulgaria.
¹² Department of Medicine, Baylor College of Medicine, Temple, TX, USA.
¹³ Division of Cardiology, The Heart Hospital Plano, Plano, TX, USA.
¹⁴ Baylor, Scott & White Research Institute, Dallas, TX, USA.
¹⁵ Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN, USA.
¹⁶ Unit of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
¹⁷ Semmelweis University Heart and Vascular Center, Budapest, Hungary.
¹⁸ Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
¹⁹ ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
²⁰ CSL Vifor, Glattbrugg, Switzerland.
²¹ Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
²² Université de Lorraine, Centre d'Investigations Cliniques-Plurithématique 14-33, Inserm U1116, CHRU Nancy, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
²³ Medical Specialties and Nephrology Department, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, and M-CRIN, Monaco, Monaco.
²⁴ University of Milano-Bicocca, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
²⁵ Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
²⁶ Division of Cardiology, University of Michigan, Ann Arbor, MI, USA.

PMID: 40607983
DOI: 10.1002/ejhf.3754

Abstract

Aims: In the DIAMOND (Patiromer for the Management of Hyperkalaemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) trial, the potassium binder patiromer enabled optimization of renin-angiotensin-aldosterone system inhibitors (RAASi) for patients with heart failure and a reduced ejection fraction (HFrEF) and current or recent hyperkalaemia. In this post-hoc analysis, we evaluated the effect of patiromer-enabled RAASi optimization on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, an established surrogate endpoint for clinical outcomes in HFrEF.

Methods and results: During screening, 539 (61.4%) of the 878 subsequently randomized patients had NT-proBNP ≥1000 pg/ml, measured prior to a 12-week run-in period on single-blinded patiromer during which RAASi were optimized. Among these patients, 165/266 (62%) in the patiromer and 172/273 (63%) in the placebo arm had follow-up NT-proBNP. For these 337 patients, we evaluated the change in NT-proBNP from screening to week 18 after randomization. NT-proBNP declined by -53% (95% confidence interval -59% to -46%; p < 0.001) in both arms combined (median absolute change: -731 [-1832, 107] pg/ml), with no significant difference between the two arms (p = 0.135). A >30% NT-proBNP reduction was observed in 93/165 (56%) patiromer and 88/172 (51%) placebo patients (p = 0.38), whereas 60/165 (36%) and 53/172 (31%), respectively, achieved NT-proBNP levels <1000 pg/ml at week 18 (p = 0.30).

Conclusions: In this post-hoc analysis of DIAMOND, patients with HFrEF and elevated (>1000 ng/ml) NT-proBNP at screening experienced clinically meaningful NT-proBNP reductions following a RAASi optimization strategy that included patiromer during the run-in phase, with no significant differences observed between patiromer and placebo groups during the randomized withdrawal phase.

Keywords: Guideline‐directed medical therapy; Heart failure with reduced ejection fraction; Hyperkalaemia; NT‐proBNP; Patiromer; Therapy optimization.

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References

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Changes in natriuretic peptide levels following patiromer-enabled optimization of medical therapy in heart failure: A post hoc analysis of the DIAMOND study

Affiliations

Changes in natriuretic peptide levels following patiromer-enabled optimization of medical therapy in heart failure: A post hoc analysis of the DIAMOND study

Authors

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials