Spironolactone With Patiromer in the Treatment of Resistant Hypertension in Chronic Kidney Disease

NCT ID: NCT03071263

Last Updated: 2021-05-12

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

295 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-23

Study Completion Date

2018-11-27

Brief Summary

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The purpose of this study is to determine if patiromer treatment in chronic kidney disease (CKD) subjects receiving spironolactone for the treatment of resistant hypertension will result in more persistent use of spironolactone through prevention of hyperkalemia and lead to improved blood pressure control compared with treatment with spironolactone alone (placebo).

Detailed Description

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Approximately 290 eligible participants with \[chronic kidney disease (CKD) on stable doses of medication\] will be randomly assigned to receive a patiromer or placebo starting dose of two packets a day, once a day.

All eligible participants will undergo a screening/run-in period (up to 4 weeks) to determine eligibility for study entry. Eligible participants will be randomized and treated for 12 weeks (Treatment Period) and followed for 2 weeks after completing the patiromer or placebo treatment. There are 8 planned clinic visits during the Treatment Period and one planned visit two weeks after the last dose of patiromer or placebo (Follow-up Period).

The dose of patiromer or placebo may be increased or decreased (titrated) based on participants' individual potassium response.

Conditions

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Hyperkalemia Resistant Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Group 1 - Patiromer

spironolactone + blinded patiromer

Group Type EXPERIMENTAL

Patiromer

Intervention Type DRUG

2 packets/day starting dose, administered orally

Spironolactone

Intervention Type DRUG

25 mg tablet/day starting dose, administered orally

Group 2 - Placebo

spironolactone + blinded placebo

Group Type EXPERIMENTAL

Placebo

Intervention Type DRUG

2 packets/day starting dose, administered orally

Spironolactone

Intervention Type DRUG

25 mg tablet/day starting dose, administered orally

Interventions

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Patiromer

2 packets/day starting dose, administered orally

Intervention Type DRUG

Placebo

2 packets/day starting dose, administered orally

Intervention Type DRUG

Spironolactone

25 mg tablet/day starting dose, administered orally

Intervention Type DRUG

Other Intervention Names

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Veltassa RLY5016 for Oral Suspension Patiromer for Oral Suspension

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years
* Taking at least three medications for blood pressure (one a diuretic)
* Uncontrolled high blood pressure
* Abnormal kidney function (with-eGFR, a measure of kidney function, of 25 - ≤ 45 mL/min/1.73m2
* Normal Blood serum Potassium in a specific range (4.3 - 5.1 mEq/L)

Exclusion Criteria

* History of untreated known causes of high blood pressure, excluding kidney disease (not CKD)
* Inability to measure BP
* Not taking high blood pressure medications as prescribed medications
* Recent change in renal function (in the past 3 months) which has required hospitalization or dialysis
* Renal transplant
* History of cancer within past 12 months
* Recent cardiovascular event with last 3 months
* Clinically significant abnormalities of heart rhythm (ventricular arrhythmia or atrial fibrillation with uncontrolled heart rate)
* Inability to take study medication
* Alcoholism
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Relypsa, Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Study Director or VP Clinical Development

Role: STUDY_DIRECTOR

Relypsa, Inc.

Locations

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Investigator Site 1012

Hollywood, Florida, United States

Site Status

Investigator Site 1023

Miami Lakes, Florida, United States

Site Status

Investigator Site 1022

Chicago, Illinois, United States

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Investigator Site 1402

Sofia, , Bulgaria

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Investiagor Site 2205

Zagreb, , Croatia

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Investigator Site 2201

Zagreb, , Croatia

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Investigator Site 2202

Zagreb, , Croatia

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Investigator Site 2203

Zagreb, , Croatia

Site Status

Investigator Site 3806

Tbilisi, , Georgia

Site Status

Investigator Site 3811

Tbilisi, , Georgia

Site Status

Investigator Site 3802

Tbilisi, , Georgia

Site Status

Investigator Site 3801

Tbilisi, , Georgia

Site Status

Investigator Site 3804

Tbilisi, , Georgia

Site Status

Investigator Site 3805

Tbilisi, , Georgia

Site Status

Investigator Site 3807

Tbilisi, , Georgia

Site Status

Investigator Site 3808

Tbilisi, , Georgia

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Investigator Site 3810

Tbilisi, , Georgia

Site Status

Investigator Site 3812

Tbilisi, , Georgia

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Investigator Site 3813

Tbilisi, , Georgia

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Investigator Site 3809

Tbilisi, , Georgia

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Investigator Site 4202

Göttingen, , Germany

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Investigator Site 4607

Balatonfüred, , Hungary

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Investigator Site 4606

Budapest, , Hungary

Site Status

Investigator Site 4611

Debrecen, , Hungary

Site Status

Investigator Site 4601

Hatvan, , Hungary

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Investigator Site 4605

Kistarcsa, , Hungary

Site Status

Investigator Site 4602

Miskolc, , Hungary

Site Status

Investigator Site 4610

Miskolc, , Hungary

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Investigator Site 4608

Mosonmagyaróvár, , Hungary

Site Status

Investigator Site 7403

Johannesburg, , South Africa

Site Status

Investiagor Site 7809

Kharkiv, , Ukraine

Site Status

Investigator Site 7803

Kharkiv, , Ukraine

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Investigator Site 7808

Kharkiv, , Ukraine

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Investigator Site 7802

Kharkiv, , Ukraine

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Investigator Site 7805

Kiev, , Ukraine

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Investigator Site 7801

Kiev, , Ukraine

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Investigator Site 7804

Zaporizhzhia, , Ukraine

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Investigator Site 7807

Zaporizhzhia, , Ukraine

Site Status

Investigator Site 8202

Leicester, , United Kingdom

Site Status

Investigator Site 8205

London, , United Kingdom

Site Status

Countries

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United States Bulgaria Croatia Georgia Germany Hungary South Africa Ukraine United Kingdom

References

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Agarwal R, Rossignol P, Budden J, Mayo MR, Arthur S, Williams B, White WB. Patiromer and Spironolactone in Resistant Hypertension and Advanced CKD: Analysis of the Randomized AMBER Trial. Kidney360. 2021 Jan 15;2(3):425-434. doi: 10.34067/KID.0006782020. eCollection 2021 Mar 25.

Reference Type DERIVED
PMID: 35369022 (View on PubMed)

Natale 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.

Reference Type DERIVED
PMID: 32588430 (View on PubMed)

Agarwal R, Rossignol P, Romero A, Garza D, Mayo MR, Warren S, Ma J, White WB, Williams B. 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. Lancet. 2019 Oct 26;394(10208):1540-1550. doi: 10.1016/S0140-6736(19)32135-X. Epub 2019 Sep 15.

Reference Type DERIVED
PMID: 31533906 (View on PubMed)

Agarwal R, Rossignol P, Garza D, Mayo MR, Warren S, Arthur S, Romero A, White WB, Williams B. Patiromer to Enable Spironolactone Use in the Treatment of Patients with Resistant Hypertension and Chronic Kidney Disease: Rationale and Design of the AMBER Study. Am J Nephrol. 2018;48(3):172-180. doi: 10.1159/000492622. Epub 2018 Sep 3.

Reference Type DERIVED
PMID: 30176673 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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2016-002657-38

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

RLY5016-207

Identifier Type: -

Identifier Source: org_study_id

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