Trial reportEuropean heart journal2022
Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial.
Trial report in European heart journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03888066 (A Multicenter, Double-blind, Placebo-controlled, Randomized Withdrawal, Parallel Group Study of Patiromer for the Management of Hyperkalemia in Subjects Receiving Renin Angiotensin Aldosterone System Inhibitor), which is not on this map. Cited by 111 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Multicenter, Double-blind, Placebo-controlled, Randomized Withdrawal, Parallel Group Study of Patiromer for the Management of Hyperkalemia in Subjects Receiving Renin Angiotensin Aldosterone System Inhibitor (RAASi) Medications for the Treatment of Heart Failure (DIAMOND)
Who cites it
111 citing papers in PubMed, 7 syntheses or guidelines pooled it, 208 citations in OpenAlex.
- Heart failure with reduced ejection fraction: a systematic review of clinical practice guidelines and recommendations.European heart journal. Quality of care & clinical outcomes · 2026Pooled it
- Efficacy and Tolerability of Sodium Zirconium Cyclosilicate or Patiromer in Managing Hyperkalemia: A Systematic Review and Meta-Analysis.Kidney360 · 2026Pooled it
- 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2026Guideline
- Interdisciplinary recommendations for recurrent hyperkalaemia: insights from the GUARDIAN-HK European Steering Committee.European heart journal. Cardiovascular pharmacotherapy · 2025Guideline
- Pooled it
- The Efficacy and Safety of Patiromer for Heart Failure Patients: A Systematic Review and Meta-Analysis.Cardiovascular drugs and therapy · 2024Pooled it
- The efficacy and safety of new potassium binders on renin-angiotensin-aldosterone system inhibitor optimization in heart failure patients: a systematic review and meta-analysis.ESC heart failure · 2024Pooled it
- Comparative analysis of randomized versus real-world populations in heart failure: DIAMOND trial vs CARE-HK registry.ESC heart failure · 2026Trial
- Net clinical benefit of patiromer for acute hyperkalemia: a post-hoc analysis of the reduce trial.Annals of medicine · 2025Trial
- Mineralocorticoid Receptor Antagonism with Finerenone: A New Era in the Management of Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025Trial
- Patiromer-Facilitated Renin-Angiotensin-Aldosterone System Inhibitor Utilization in Patients with Heart Failure with or without Comorbid Chronic Kidney Disease: Subgroup Analysis of DIAMOND Randomized Trial.American journal of nephrology · 2024Trial
- Potassium reduction with sodium zirconium cyclosilicate in patients with heart failure.ESC heart failure · 2023Trial
- Early mineralocorticoid receptor antagonism for end-organ protection in hypertension: Implications for disparities and rethinking the timing paradigm.Dialogues in health · 2026Review
- Cardiovascular outcomes with potassium binders in patients with heart failure and hyperkalaemia.ESC heart failure · 2026Observational
- Potassium binders and continuation of renin-angiotensin system inhibitors/mineralocorticoid receptor antagonist in chronic kidney disease and heart failure (the DEMONSTRATE database).Journal of internal medicine · 2026Observational
- Age-related differences in the intake of heart failure therapy among participants from the MyoVasc study.European geriatric medicine · 2026Observational
- Emerging Strategies for Cardio-Renal Protection Beyond RAAS Blockade:Saudi medical journal · 2026Review
- Prognostic Impact of Baseline Potassium Abnormalities in Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Cohort Study.Medical sciences (Basel, Switzerland) · 2026Article
- Spironolactone or Finerenone for Cardiovascular and Kidney Protection in Patients with Moderate CKD?American journal of cardiovascular drugs : drugs, devices, and other interventions · 2026Review
- Epidemiology of hyperkalemia among US emergency department patients without end-stage renal disease from 2016 to 2024.Clinical and experimental emergency medicine · 2026Article
51 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
41 authors at 20 institutions in 23 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsTo investigate the impact of patiromer on the serum potassium level and its ability to enable specified target doses of renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND
resultsA total of 1642 patients with HFrEF and current or a history of RAASi-related hyperkalemia were screened and 1195 were enrolled in the run-in phase with patiromer and optimization of the RAASi therapy [≥50% recommended dose of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, and 50 mg of mineralocorticoid receptor antagonist (MRA) spironolactone or eplerenone]. Specified target doses of the RAASi therapy were achieved in 878 (84.6%) patients; 439 were randomized to patiromer and 439 to placebo. All patients, physicians, and outcome assessors were blinded to treatment assignment. The primary endpoint was between-group difference in the adjusted mean change in serum potassium. Five hierarchical secondary endpoints were assessed. At the end of treatment, the median (interquartile range) duration of follow-up was 27 (13-43) weeks, the adjusted mean change in potassium was +0.03 mmol/l in the patiromer group and +0.13 mmol/l in the placebo group [difference in the adjusted mean change between patiromer and placebo: -0.10 mmol/l (95% confidence interval, CI -0.13, 0.07); P < 0.001]. Risk of hyperkalemia >5.5 mmol/l [hazard ratio (HR) 0.63; 95% CI 0.45, 0.87; P = 0.006), reduction of MRA dose (HR 0.62; 95% CI 0.45, 0.87; P = 0.006), and total adjusted hyperkalemia events/100 person-years (77.7 vs. 118.2; HR 0.66; 95% CI 0.53, 0.81; P < 0.001) were lower with patiromer. Hyperkalemia-related morbidity-adjusted events (win ratio 1.53, P < 0.001) and total RAASi use score (win ratio 1.25, P = 0.048) favored the patiromer arm. Adverse events were similar between groups.
conclusionConcurrent use of patiromer and high-dose MRAs reduces the risk of recurrent hyperkalemia (ClinicalTrials.gov: NCT03888066).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.