Abstract 13944: The Efficacy and Safety of New Potassium Binders on RASSi Optimization in Hyperkalemic Patients With Heart Failure: A Systematic-Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: Guideline-directed medical therapy (GDMT) has improved outcomes in patients with heart failure (HF), including the use of renin-angiotensin-aldosterone system inhibitors (RAASi); angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), angiotensin receptor/neprilysin inhibitor (ANRi), and mineralocorticoid receptor antagonists (MRAs). RAASi can hinder the excretion of potassium, resulting in hyperkalemia. New potassium binders (NPB) (patiromer and sodium zirconium cyclosilicate) can prevent this adverse effect; however, the efficacy and safety of NPB for this indication have not been fully established. Methods: We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through April 26th, 2023. We used the fixed-effect model to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI). Results: We included five RCTs with a total of 1,399 patients. BPB was significantly associated with successful MRA optimization (RR: 1.13 with 95% CI [1.02, 1.25], P=0.02), decreased patients with MRA at less than target dose (RR: 0.72 with 95% CI [0.57, 0.90], P=0.004), and decreased hyperkalemic episodes (RR: 0.50 with 95% CI [0.32, 0.79], P=0.003). However, there was no difference between NPB and placebo regarding ACEi/ARB/ANRi optimization (RR: 1.02 with 95% CI [0.89, 1.17], P=0.76) and serum potassium change (MD: -0.31 with 95% CI [-0.61, 0.00], P=0.05). Conclusion: NPB can successfully improve GDMT outcomes by enhancing MRA optimization and decreasing hyperkalemic episodes. However, data regarding the NPB effect on ACEi/ARB/ANRi optimization remain scarce. Therefore, future RCTs should investigate it and conduct a head-to-head comparison of NPB.