patiromer Evidence: Trial Results and Peer-Reviewed Publications

Hipa.ai Research · Source: PubMed & ClinicalTrials.gov / AACT · Last updated:

The clinical evidence base for patiromer comprises 41 peer-reviewed publications across 15 journals, 4 pivotal-trial primary-outcome rows reported to ClinicalTrials.gov, spanning indications including Kidney Diseases, Hyperkalemia, and Emergencies. Most recent publication: Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): a randomised controlled trial in the emergency department., BMJ Open, 2026.

Top peer-reviewed publications

Curated set of pivotal-trial result papers and recent publications in high-tier journals.

  1. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial.
    Pitt B, Anker SD, Bushinsky DA, et al. · Eur Heart J · 2011
  2. The potassium regulator patiromer affects serum and stool electrolytes in patients receiving hemodialysis.
    Amdur RL, Paul R, Barrows ED, et al. · Kidney Int · 2021
  3. Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): a randomised controlled trial in the emergency department.
    Rafique Z, Safdar B, Duanmu Y, et al. · BMJ Open · 2026
  4. Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): design of a multicentre, randomised, double-blind, placebo-controlled, parallel-group study.
    Rafique Z, Budden J, Quinn CM, et al. · BMJ Open · 2023
  5. Twice-Weekly Hemodialysis With Adjuvant Pharmacotherapy and Transition to Thrice-Weekly Hemodialysis: A Pilot Study.
    Murea M, Patel A, Highland BR, et al. · Am J Kidney Dis · 2022
  6. Patiromer for Heart Failure Medication Optimization in Patients With Current or Past Hyperkalemia: DIAMOND Subanalysis.
    Coats AJS, Anker SD, Lund LH, et al. · JACC Heart Fail · 2024
  7. A randomized study to compare oral potassium binders in the treatment of acute hyperkalemia.
    Cañas AE, Troutt HR, Jiang L, et al. · BMC Nephrol · 2023
  8. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial.
    Agarwal R, Rossignol P, Romero A, et al. · Lancet · 2019

Primary-outcome results across pivotal trials

Per-arm reported values from Phase 2/3 and Phase 3 trials with results posted to ClinicalTrials.gov.

TrialIndicationPrimary endpointArmValue
NCT01810939
OPAL
HyperkalemiaChange in Serum Potassium From Part A Baseline to Part A Week 4
Part A Baseline to Part A Week 4
Part A Patiromer-1.01 mEq/L (±0.031 Standard Error)
NCT01810939
OPAL
HyperkalemiaChange in Serum Potassium From Part B Baseline
Part B Baseline to Part B Week 4 or first local laboratory serum potassium < 3.8 mEq/L or ≥ 5.5 mEq/L
Part B Patiromer0 mEq/L
Part B Placebo0.72 mEq/L
NCT03740048
TWOPLUS-HD
Kidney DiseasesPatients' Adherence to Study Protocol
6 months, 12 months, 24 months
Conventional Hemodialysis Regimen19 Participants
Conventional Hemodialysis Regimen10 Participants
Conventional Hemodialysis Regimen24 Participants
Hemodialysis and Pharmacologic Therapy19 Participants
Hemodialysis and Pharmacologic Therapy22 Participants
Hemodialysis and Pharmacologic Therapy10 Participants
NCT03888066
DIAMOND
HyperkalemiaChanges in Serum K+ Levels From Baseline
Mean duration of exposure: 227.9 days for Patiromer and 234.5 days for Placebo
Patiromer0.029 Milliequivalents Per Liter (mEq/l) (±0.019 Standard Error)
Placebo0.127 Milliequivalents Per Liter (mEq/l) (±0.019 Standard Error)

Publications by year

19812026: 41 publications.

1981
1
2002
2
2003
1
2004
2
2007
2
2009
1
2010
2
2011
2
2015
3
2016
2
2017
1
2018
2
2019
3
2020
2
2021
4
2022
6
2023
2
2024
2
2026
1

Publications by indication

Kidney Diseases (23)

  • Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function.
    Kidney Int Rep · 2024 · PMID 29270499 · NCT03740048
  • Twice-Weekly Hemodialysis With Adjuvant Pharmacotherapy and Transition to Thrice-Weekly Hemodialysis: A Pilot Study.
    Am J Kidney Dis · 2022 · PMID 34933066 · NCT03740048
  • Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis.
    BMC Nephrol · 2022 · PMID 36167537 · NCT03740048
  • Precision medicine approach to dialysis including incremental and decremental dialysis regimens.
    Curr Opin Nephrol Hypertens · 2021 · PMID 33165001 · NCT03740048
  • Renal replacement treatment initiation with twice-weekly versus thrice-weekly haemodialysis in patients with incident dialysis-dependent kidney disease: rationale and design of the TWOPLUS pilot clinical trial.
    BMJ Open · 2021 · PMID 34031117 · NCT03740048

Hyperkalemia (15)

  • Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): a randomised controlled trial in the emergency department.
    BMJ Open · 2026 · PMID 41730555 · NCT04443608
  • Patiromer for Heart Failure Medication Optimization in Patients With Current or Past Hyperkalemia: DIAMOND Subanalysis.
    JACC Heart Fail · 2024 · PMID 39340493 · NCT03888066
  • Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): design of a multicentre, randomised, double-blind, placebo-controlled, parallel-group study.
    BMJ Open · 2023 · PMID 37308268 · NCT04443608
  • Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial.
    Eur Heart J · 2022 · PMID 35900838 · NCT03888066
  • 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 · 2022 · PMID 34136782 · NCT01371747

Emergencies (3)

Publications by journal

Trial-results highlights

In the NCT01810939 (OPAL) trial, Part A investigated the change in serum potassium from Part A baseline to Part A Week 4. In this part of the study, the patiromer arm showed a change in serum potassium of -1.01 mEq/L.

Part B of the NCT01810939 (OPAL) trial reported a median change in serum potassium of 0 mEq/L for the patiromer arm, while the placebo arm reported a median change of 0.72 mEq/L. Another study, NCT03888066 (DIAMOND), investigated changes in serum K+ levels from baseline. The mean duration of exposure in this trial was 227.9 days for the patiromer arm and 234.5 days for the placebo arm. In NCT03888066, the patiromer arm reported a change of 0.029 mEq/l, and the placebo arm reported a change of 0.127 mEq/l.

The NCT03740048 (TWOPLUS-HD) study focused on patients' adherence to the study protocol. This trial reported participant counts for adherence at different time points:

  • For the conventional hemodialysis regimen, adherence was reported for 19 participants at 6 months, 10 participants at 12 months, and 24 participants at 24 months.
  • For the hemodialysis and pharmacologic therapy regimen, adherence was reported for 19 participants at 6 months, 22 participants at 12 months, and 10 participants at 24 months.

All values are sourced from primary registry reporting, and individual papers should be consulted for clinical decisions.

All patiromer publications (41)

2026 (1 paper)

  1. Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): a randomised controlled trial in the emergency department.
    Rafique Z, Safdar B, Duanmu Y, et al. · BMJ Open · 2026 · Derived

2024 (2 papers)

  1. Patiromer for Heart Failure Medication Optimization in Patients With Current or Past Hyperkalemia: DIAMOND Subanalysis.
    Coats AJS, Anker SD, Lund LH, et al. · JACC Heart Fail · 2024 · Derived
  2. Feasibility of Incremental 2-Times Weekly Hemodialysis in Incident Patients With Residual Kidney Function.
    Chin AI, Appasamy S, Carey RJ, et al. · Kidney Int Rep · 2024 · Background

2023 (2 papers)

  1. Patiromer utility as an adjunct treatment in patients needing urgent hyperkalaemia management (PLATINUM): design of a multicentre, randomised, double-blind, placebo-controlled, parallel-group study.
    Rafique Z, Budden J, Quinn CM, et al. · BMJ Open · 2023 · Derived
  2. A randomized study to compare oral potassium binders in the treatment of acute hyperkalemia.
    Cañas AE, Troutt HR, Jiang L, et al. · BMC Nephrol · 2023 · Derived

2022 (6 papers)

  1. Twice-Weekly Hemodialysis With Adjuvant Pharmacotherapy and Transition to Thrice-Weekly Hemodialysis: A Pilot Study.
    Murea M, Patel A, Highland BR, et al. · Am J Kidney Dis · 2022 · Derived
  2. Patient-reported outcomes in a pilot clinical trial of twice-weekly hemodialysis start with adjuvant pharmacotherapy and transition to thrice-weekly hemodialysis vs conventional hemodialysis.
    Murea M, Highland BR, Yang W, et al. · BMC Nephrol · 2022 · Derived
  3. Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial.
    Butler J, Anker SD, Lund LH, et al. · Eur Heart J · 2022 · Derived
  4. 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.
    Bakris GL, Woods SD, Alvarez PJ, et al. · Kidney Med · 2022 · Derived
  5. Patiromer and Spironolactone in Resistant Hypertension and Advanced CKD: Analysis of the Randomized AMBER Trial.
    Agarwal R, Rossignol P, Budden J, et al. · Kidney360 · 2022 · Derived
  6. The Cost of Hyperkalemia in the United States.
    Betts KA, Woolley JM, Mu F, et al. · Kidney Int Rep · 2022 · Background

2021 (4 papers)

  1. The potassium regulator patiromer affects serum and stool electrolytes in patients receiving hemodialysis.
    Amdur RL, Paul R, Barrows ED, et al. · Kidney Int · 2021 · Trial result
  2. Precision medicine approach to dialysis including incremental and decremental dialysis regimens.
    Murea M · Curr Opin Nephrol Hypertens · 2021 · Derived
  3. Renal replacement treatment initiation with twice-weekly versus thrice-weekly haemodialysis in patients with incident dialysis-dependent kidney disease: rationale and design of the TWOPLUS pilot clinical trial.
    Murea M, Moossavi S, Fletcher AJ, et al. · BMJ Open · 2021 · Derived
  4. Recurrent Hyperkalemia in Renin-Angiotensin-Aldosterone System Inhibitor (RAASi) Treatment: Stuck between a Rock and a Hard Place.
    Bolaños JA, Seliger SL · Clin J Am Soc Nephrol · 2021 · Derived

2020 (2 papers)

  1. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease.
    Natale P, Palmer SC, Ruospo M, et al. · Cochrane Database Syst Rev · 2020 · Derived
  2. New therapies for hyperkalemia.
    Leon SJ, Harasemiw O, Tangri N, et al. · Curr Opin Nephrol Hypertens · 2020 · Background

2019 (3 papers)

  1. 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.
    Pitt B, Bakris GL, Weir MR, et al. · ESC Heart Fail · 2019 · Derived
  2. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial.
    Agarwal R, Rossignol P, Romero A, et al. · Lancet · 2019 · Derived
  3. Patiromer to Enable Spironolactone Use in the Treatment of Patients with Resistant Hypertension and Chronic Kidney Disease: Rationale and Design of the AMBER Study.
    Agarwal R, Rossignol P, Garza D, et al. · Am J Nephrol · 2019 · Derived

2018 (2 papers)

  1. Evaluation of an individualized dose titration regimen of patiromer to prevent hyperkalaemia in patients with heart failure and chronic kidney disease.
    Pitt B, Bushinsky DA, Kitzman DW, et al. · ESC Heart Fail · 2018 · Derived
  2. Estimating Time-averaged Serum Urea Nitrogen Concentration during Various Urine Collection Periods: A Prediction Equation for Thrice Weekly and Biweekly Dialysis Schedules.
    Daugirdas JT · Semin Dial · 2018 · Background

2017 (1 paper)

  1. Explaining trends and variation in timing of dialysis initiation in the United States.
    Li Y, Jin Y, Kapke A, et al. · Medicine (Baltimore) · 2017 · Background

2016 (2 papers)

  1. Effect of patiromer on reducing serum potassium and preventing recurrent hyperkalaemia in patients with heart failure and chronic kidney disease on RAAS inhibitors.
    Pitt B, Bakris GL, Bushinsky DA, et al. · Eur J Heart Fail · 2016 · Background
  2. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update.
    National Kidney Foundation · Am J Kidney Dis · 2016 · Background

2015 (3 papers)

  1. Association of initial twice-weekly hemodialysis treatment with preservation of residual kidney function in ESRD patients.
    Zhang M, Wang M, Li H, et al. · Am J Nephrol · 2015 · Background
  2. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors.
    Weir MR, Bakris GL, Bushinsky DA, et al. · N Engl J Med · 2015 · Background
  3. Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease: The AMETHYST-DN Randomized Clinical Trial.
    Bakris GL, Pitt B, Weir MR, et al. · JAMA · 2015 · Background

2011 (2 papers)

  1. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial.
    Pitt B, Anker SD, Bushinsky DA, et al. · Eur Heart J · 2011 · Trial result
  2. Contribution of residual function to removal of protein-bound solutes in hemodialysis.
    Marquez IO, Tambra S, Luo FY, et al. · Clin J Am Soc Nephrol · 2011 · Background

2010 (2 papers)

  1. Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study.
    Shafi T, Jaar BG, Plantinga LC, et al. · Am J Kidney Dis · 2010 · Background
  2. Standard Kt/Vurea: a method of calculation that includes effects of fluid removal and residual kidney clearance.
    Daugirdas JT, Depner TA, Greene T, et al. · Kidney Int · 2010 · Background

2009 (1 paper)

  1. Comparison of residual renal function in patients undergoing twice-weekly versus three-times-weekly haemodialysis.
    Lin YF, Huang JW, Wu MS, et al. · Nephrology (Carlton) · 2009 · Background

2007 (2 papers)

  1. Association between serum bicarbonate and death in hemodialysis patients: is it better to be acidotic or alkalotic?
    Wu DY, Shinaberger CS, Regidor DL, et al. · Clin J Am Soc Nephrol · 2007 · Background
  2. Serum and dialysate potassium concentrations and survival in hemodialysis patients.
    Kovesdy CP, Regidor DL, Mehrotra R, et al. · Clin J Am Soc Nephrol · 2007 · Background

2004 (2 papers)

  1. Relative contribution of residual renal function and different measures of adequacy to survival in hemodialysis patients: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2.
    Termorshuizen F, Dekker FW, van Manen JG, et al. · J Am Soc Nephrol · 2004 · Background
  2. Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study.
    Lo WK, Ho YW, Li CS, et al. · Kidney Int · 2004 · Background

2003 (1 paper)

  1. Predictors of the rate of decline of residual renal function in incident dialysis patients.
    Jansen MA, Hart AA, Korevaar JC, et al. · Kidney Int · 2003 · Background

2002 (2 papers)

  1. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial.
    Paniagua R, Amato D, Vonesh E, et al. · J Am Soc Nephrol · 2002 · Background
  2. Effect of dialysis dose and membrane flux in maintenance hemodialysis.
    Eknoyan G, Beck GJ, Cheung AK, et al. · N Engl J Med · 2002 · Background

1981 (1 paper)

  1. Effect of the hemodialysis prescription on patient morbidity: report from the National Cooperative Dialysis Study.
    Lowrie EG, Laird NM, Parker TF, et al. · N Engl J Med · 1981 · Background

Sources and methodology

This page summarizes published evidence for general reference and does not constitute medical advice. For clinical decisions, consult the linked primary publications and your healthcare provider. Data sourced from PubMed and the ClinicalTrials.gov / AACT database maintained by the Clinical Trials Transformation Initiative (CTTI).