Evaluation of Patiromer in Heart Failure Patients

This was a double-blind, randomized, placebo-controlled, parallel-group, multiple-dose study
in congestive heart failure participants. Depending on the outcome from the initial cohort
of 100 participants (Part 1), a second cohort of 170 participants could have been enrolled
(Part 2). Based on the results of Part 1 of the study, Part 2 was not conducted.

Participants were randomly assigned to and received patiromer (30 g/day) or placebo for up
to 28 days. All participants also received spironolactone; the initial spironolactone dose
was 25 mg daily and was increased to 50 mg daily for participants who had a serum potassium
≤ 5.1 mEq/L on treatment Day 14. Study visits occurred on treatment Days 3, 7, 14, 17, 21
and 28. A safety follow-up contact was made 7 days after administration of last dose of
study drug.

Inclusion Criteria:

- Participants with chronic heart failure clinically indicated to receive
spironolactone therapy, aged 18 years or older with serum potassium level of 4.3 -
5.1 mEq/L at screening and baseline, AND (1) chronic kidney disease (GFR < 60 mL/min)
OR (2) documented history of hyperkalemia within the last 6 months

- Females of child-bearing potential must be non-lactating, must have a negative serum
pregnancy test at screening, and must have used a highly effective form of
contraception for at least 3 months before study drug administration, during the
study, and for one month after study completion

- Male participants and/or their female partners of child-bearing potential must use a
highly effective form of contraception during the study and for 3 months after study
completion

- Must sign informed consent document

Exclusion Criteria:

- History of bowel obstruction, swallowing disorders, severe gastrointestinal disorders
or major gastrointestinal surgery

- Uncorrected hemodynamically significant primary valvular disease, known obstructive
or restrictive cardiomyopathy, uncontrolled or hemodynamically unstable arrhythmia

- Coronary-artery bypass graft, percutaneous intervention (e.g. cardiac,
cerebrovascular, aortic), or major surgery including thoracic and cardiac, within 3
months prior to baseline or anticipated need during study participation

- Heart transplant recipient, or anticipated need for transplant during study
participation

- Any of the following events having occurred within 3 months prior to baseline:
unstable angina as judged by the Investigator, unresolved acute coronary syndrome,
transient ischemic attack or stroke

- Current dialysis participant, or anticipated need for dialysis during study
participation

- Prior kidney transplant, or anticipated need for transplant during study
participation

- Metastatic, late-stage or end-stage cancer with < 12 months life expectancy

- History of alcoholism or drug/chemical abuse within 1 year

- QTcB interval > 500 msec (Bazett's correction formula)

- Sustained systolic blood pressure > 170 or < 90 mmHg

- Liver enzymes (ALT, AST) > 3 times upper limit of normal

- Use of oral cardiac medications (including loop and thiazide diuretics) that have not
been stable for at least 21 days prior to baseline and are not anticipated to remain
stable during study participation

- Use of any IV cardiac medications within 21 days prior to baseline, or their
anticipated need during study participation.

- Current use of polymer-based drugs (e.g. Renagel, Kayexalate, Welchol, Colestid),
other phosphate binders or potassium binders, calcium supplements, antacids (eg TUMS,
Maalox), or their anticipated need during study participation

- Use of aldosterone antagonist in the last 30 days prior to baseline, unless was
discontinued due to hyperkalemia

- Use of potassium sparing medication and/or potassium supplements in the last 30 days
prior to baseline

- Use of any investigational medication, 30 days or 5 half-lives whichever is longer,
prior to baseline

- Participants who have taken investigational product in this study, or a previous
patiromer study

- Inability to consume the study medication, or, in the opinion of the Investigator,
inability to comply with the protocol

- In the opinion of the Investigator, any medical condition, uncontrolled systemic
disease, serious intercurrent illness, or extenuating circumstance occurring or
persisting, within 30 days prior to baseline, that would significantly decrease study
compliance or jeopardize the safety of the participant or affect the validity of the
trial results