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

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.

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