#3664 EVALUATION OF THE INTRODUCTION OF NOVEL POTASSIUM BINDERS IN ROUTINE CARE: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT
Notice bibliographique
Résumé
Abstract Background and Aims The pharmacological management of hyperkalemia has traditionally considered sodium polystyrene sulfonate (SPS) and, since late 2018, the novel potassium (K+) binders Patiromer and Sodium Zirconium Cyclosilicate (SZC). This study evaluated their patterns of use, duration of treatment and relative effectiveness in reducing plasma K+ levels in Stockholm´s contemporary routine care. Method Observational study of all adults who newly-filled a prescription for SPS, Patiromer or SZC during 2019–2021 in Stockholm, Sweden. Sweden offers universal healthcare and covers the cost of prescribed medications. We described patient characteristics of new initiators, including their comorbidities, medication use, eGFR and pre-treatment plasma K+ levels. We then quantified treatment duration by evaluating all subsequent dispensations. Lastly, we compared their relative efficacy by evaluating post-treatment K+ during the following 60 days through multivariable logistic regression. Because the frequency and pattern of K+ monitoring differed per patient, we considered the K+ test closest to the end of 15-day intervals. Then, we estimated odds ratios and 95% confidence intervals of maintaining normokalemia (K+<5.1 and <5.5 mmol/L) for the novel binders vs SPS. Results During 2019–2021, 1879 adults started treatment with SPS, and 147 with novel binders (41 with Patiromer and 106 with SZC). The median K+ at initiation for all three treatments was 5.7 mmol/L. Median eGFR was higher among Patiromer initiators (58 mL/min/1.73 m2) than initiators of SZC (31 mL/min/1.73m2) or SPS (37 mL/min/1.73m2). Patients on SPS stayed mean 61 days on treatment, and 14% filled three or more consecutive prescriptions suggesting chronic use. Patients on novel binders stayed mean 109 days on treatment, and 49% filled three or more prescriptions (Panel A). After 15 days of treatment, mean plasma K+ similarly decreased to 4.6 (4.3-5.1) and 4.8 (4.5-5.2) mmol/L in patients with SPS and novel binders, respectively, and this level was maintained during the 60 days post-treatment (Panel B). 76% of SPS users reached a potassium value <5.1 mmol/L at day 15 versus 67% of patients in the novel binder group (between group difference 9%; 95% CI 0.92-2.57; p-value 0.07; Panel C). Furthermore, the proportion of patients with K+ <5.5 mmol/L at day 15 was 91% for SPS and 85% for novel binders (Panel D). In multivariable logistic regression, the odds ratio for novel binders (vs SPS) in reaching K+ targets (K+ <5.1 mmol/L) after 15 days was 0.68 (95% CI 0.4-1.17) and 0.78 (95% CI 0.42-1.44) after 30 days. Conclusion We observe modest use of novel K+ binders in Stockholm's contemporary practice, with longer treatment lengths than SPS. Both SPS and novel binders showed similar efficacy in achieving normal potassium values during the first 15 days of treatment and subsequent 2 months.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».