MP385RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITOR PRESCRIPTION PATTERNS IN HEMODIALYSIS PATIENTS: RESULTS FROM THE INTERNATIONAL DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS)
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Many hemodialysis (HD) patients have one or more indication for prescription of a renin-angiotensin-aldosterone system inhibitor (RAASi), including hypertension (HTN) or congestive heart failure (CHF); however, use of these drugs may be limited by adverse events such as hyperkalemia. We evaluated variation in real-world RAASi prescription patterns in an international cohort of HD patients. METHODS: We analysed RAASi prescription in a cross-section of HD patients enrolled in phases 2-5 (2002-2015) of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Patients were stratified by length of time on HD (short-term HD [ST; <120 days] and long-term HD [LT; >120 days]) and region (N. America [US and Canada], Europe/Australia/New Zealand [E/A/NZ], and Japan). Baseline RAASi prescription was assessed overall, by comorbidities (diabetes, CHF, HTN, as based on medical history collected at study entry), and by serum potassium (K+) level. RESULTS: A total of 11,710 and 37,852 patients comprised the ST and LT groups, respectively. The majority of ST and LT patients had comorbid HTN (86% and 83%, respectively); many also had diabetes (49% and 42%) and CHF (30% for both). In 2012-2015, RAASi prescriptions were more prevalent in Japan (58% for ST and 49% for LT) than other regions (N. America: 31% [ST] and 39% [LT]; E/A/NZ: 40% [ST] and 34% [LT]). The type of RAASi drug prescribed varied by region. From 2012-2015, in ST patients in N. America, E/A/NZ, and Japan, respectively, angiotensin-converting enzyme inhibitors (ACEi) were prescribed as single therapy to 19%, 17%, and 2%, angiotensin II receptor blockers (ARB) to 10%, 18%, and 50%, and ACEi + ARB to 0%, 2%, and 4%. Prescription patterns across regions were consistent among LT patients. In all regions, RAASi prescriptions appear to be more common in ST and LT patientswith serum K+ <5.0 vs. >5.0 mEq/L. More ST and LT patients with diabetes and HTN received RAASi than patients without these comorbidities across all regions; this trend did not hold true for CHF (Figure). MP385 Figure
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".