Patient Profiles: Daniel

Patient Profiles

VELTASSA^®

Meet Daniel

05.03.20

Daniel is doing well on his current treatment, but his elevated potassium may compromise his RAASi therapy

Medical history
HFrEF NYHA II CKD IIIB	Hypertension History of myocardial infarction
Concomitant medications Carvedilol: 50 mg Candesartan: 32 mg Spironolactone: 25 mg Furosemide: 40 mg Aspirin: 100 mg	Clinical findings NT-proBNP: 1002 pg/mL Creatinine: 1.9 mg/dL eGFR: 38 mL/min/1.73m² Proteinuria: A2 Potassium: 5.6 mEq/L

How can Elena re-start irbesartan and control her K⁺ long-term?

What do the guidelines say?

HEART FAILURE PATIENT WITH CKD

What would you do in Daniel’s case?

Stop spironolactone treatment

Choose treatment

Increase furosemide dose

Choose treatment

Overall I feel fine and I enjoy my daily walks. However, I do feel a bit tired and weak from time to time.”

Kaplan–Meier analysis of the probability of survival²

Reasons for not tolerating MRA therapy in HF patients¹

07.09.20

With his spironolactone treatment stopped, Daniel’s physical condition and QoL has substantially worsened

Physical examination

Mild oedema of ankles with jugular venous pressure slightly elevated after exertion; subsiding at rest
Bilateral crackles
NYHA III

Concomitant medications

Carvedilol: 50 mg
Candesartan: 32 mg
Spironolactone: 25 mg
Furosemide: 40 mg
Aspirin: 100 mg

Clinical findings

NT-proBNP: 1002 5128 pg/mL
Creatinine: 2.0 mg/dL
eGFR: 38 mL/min/1.73m²
Proteinuria: A2
Potassium: 5.6 5.2 mEq/L
EF: 29%
BP: 123/82 mm Hg

What do the guidelines say?

I am really struggling to walk more than 15 minutes. I just run out of breath if I walk any further and my whole body hurts. At night I am barely able to rest and I constantly cough, which doesn’t help. I am also quite concerned about how swollen my ankles have become.”

HEART FAILURE PATIENT WITH CKD

What do the guidelines say?

In the latest ESC 2021 Guidelines, Veltassa^® is considered a treatment option for the management of hyperkalemia in patients with HF.⁴

New K⁺ binders may allow the initiation or up-tritration of RAASi in a larger proportion of patients”⁴

Can Veltassa^® enable Daniel to re-introduce spironolactone while controlling his K⁺ levels long-term?

Learn more about the use of spirolactone in CKD and rHTN patients through the AMBER trial

Find out more

How can Elena re-start irbesartan and control her K⁺ long-term?

What do the guidelines say?

HEART FAILURE PATIENT WITH CKD

What would you do in Daniel’s case?

An ESC registry showed that

31^%

of MRA intolerance in HF patients is due to hyperkalemia, compromising their benefit on improved outcomes¹*

Show data

A landmark study demonstrated a

30^%

reduction in mortality risk in HF patients when adding an MRA (spironolactone) to ACEis/ARBs²

Show data

Assess outcome

Kaplan–Meier analysis of the probability of survival²

Reasons for not tolerating MRA therapy in HF patients¹

07.09.20

With his spironolactone treatment stopped, Daniel’s physical condition and QoL has substantially worsened

Physical examination

Mild oedema of ankles with jugular venous pressure slightly elevated after exertion; subsiding at rest
Bilateral crackles
NYHA III

Concomitant medications

Carvedilol: 50 mg
Candesartan: 32 mg
Spironolactone: 25 mg
Furosemide: 40 mg
Aspirin: 100 mg

Clinical findings

NT-proBNP: 1002 5128 pg/mL
Creatinine: 2.0 mg/dL
eGFR: 38 mL/min/1.73m²
Proteinuria: A2
Potassium: 5.6 5.2 mEq/L
EF: 29%
BP: 123/82 mm Hg

What do the guidelines say?

I am really struggling to walk more than 15 minutes. I just run out of breath if I walk any further and my whole body hurts. At night I am barely able to rest and I constantly cough, which doesn’t help. I am also quite concerned about how swollen my ankles have become.”

HEART FAILURE PATIENT WITH CKD

What do the guidelines say?

In the latest ESC 2021 Guidelines, Veltassa^® is considered a treatment option for the management of hyperkalemia in patients with HF.⁴

New K⁺ binders may allow the initiation or up-tritration of RAASi in a larger proportion of patients”⁴

Can Veltassa^® enable Daniel to re-introduce spironolactone while controlling his K⁺ levels long-term?

Learn more about the use of spirolactone in CKD and rHTN patients through the AMBER trial

Find out more

How can Elena re-start irbesartan and control her K⁺ long-term?

What do the guidelines say?

HEART FAILURE PATIENT WITH CKD

What would you do in Daniel’s case?

Loop diuretics can be effective

59^%

decrease in risk of hyperkalemia demonstrated
with use of loop diuretics³

However, they have several limitations:³

Efficacy depends on residual renal function (until diuresis is present)
Increased risk for gout and diabetes
May produce:

Volume contraction
Decreased distal nephron flow
Worsening kidney function
Reduced K⁺ excretion

Assess outcome

Kaplan–Meier analysis of the probability of survival²

Reasons for not tolerating MRA therapy in HF patients¹

07.09.20

With his spironolactone treatment stopped, Daniel’s physical condition and QoL has substantially worsened

Physical examination

Mild oedema of ankles with jugular venous pressure slightly elevated after exertion; subsiding at rest
Bilateral crackles
NYHA III

Concomitant medications

Carvedilol: 50 mg
Candesartan: 32 mg
Spironolactone: 25 mg
Furosemide: 40 mg
Aspirin: 100 mg

Clinical findings

NT-proBNP: 1002 5128 pg/mL
Creatinine: 2.0 mg/dL
eGFR: 38 mL/min/1.73m²
Proteinuria: A2
Potassium: 5.6 5.2 mEq/L
EF: 29%
BP: 123/82 mm Hg

What do the guidelines say?

I am really struggling to walk more than 15 minutes. I just run out of breath if I walk any further and my whole body hurts. At night I am barely able to rest and I constantly cough, which doesn’t help. I am also quite concerned about how swollen my ankles have become.”

HEART FAILURE PATIENT WITH CKD

What do the guidelines say?

In the latest ESC 2021 Guidelines, Veltassa^® is considered a treatment option for the management of hyperkalemia in patients with HF.⁴

New K⁺ binders may allow the initiation or up-tritration of RAASi in a larger proportion of patients”⁴

Can Veltassa^® enable Daniel to re-introduce spironolactone while controlling his K⁺ levels long-term?

Learn more about the use of spirolactone in CKD and rHTN patients through the AMBER trial

Find out more

These case studies are fictional and not based on actual patients. Models have been used to represent patients.

Meet Elena

Elena has CKD IIIB with diabetic nephropathy

Learn more

Meet Daniel

Daniel is doing well on his current treatment, but his elevated potassium may compromise his RAASi therapy

How can Elena re-start irbesartan and control her K+ long-term?

What would you do in Daniel’s case?

With his spironolactone treatment stopped, Daniel’s physical condition and QoL has substantially worsened

What do the guidelines say?

Learn more about the use of spirolactone in CKD and rHTN patients through the AMBER trial

How can Elena re-start irbesartan and control her K+ long-term?

What would you do in Daniel’s case?

31%

30%

With his spironolactone treatment stopped, Daniel’s physical condition and QoL has substantially worsened

What do the guidelines say?

Learn more about the use of spirolactone in CKD and rHTN patients through the AMBER trial

How can Elena re-start irbesartan and control her K+ long-term?

What would you do in Daniel’s case?

59%

With his spironolactone treatment stopped, Daniel’s physical condition and QoL has substantially worsened

What do the guidelines say?

Learn more about the use of spirolactone in CKD and rHTN patients through the AMBER trial

Meet Elena

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How can Elena re-start irbesartan and control her K⁺ long-term?

How can Elena re-start irbesartan and control her K⁺ long-term?

31^%

30^%

How can Elena re-start irbesartan and control her K⁺ long-term?

59^%