FP151SODIUM POLYSTYRENE SULFONATE, PRACTICE PATTERNS AND ASSOCIATED ADVERSE EVENT RISK; A NATIONWIDE ANALYSIS FROM THE SWEDISH RENAL REGISTER
Bibliographic record
Abstract
INTRODUCTION: Sodium polystyrene sulfonate (SPS) is licensed in Sweden for acute hyperkalemia treatment in patients with CKD, but also prescribed off-label for prevention. Despite long-standing clinical use, SPS practice patterns and associated adverse event risk remains unknown. METHODS: Observational study of all nephrologist-referred patients with CKD stage 3-5 initiating SPS in Sweden during 2007-2016. SPS users were 1:2 matched with non-SPS users (controls) and the following dispensation regimes were defined: isolated dispensation and chronic per label (45-60 g SPS/day), occasional (45 g/week) or sporadic (15 g/week) use. Cox proportional hazards evaluated the risk of adverse outcomes within 1 year, including severe (intestinal ischemia, thrombosis or ulceration/perforation) and minor (de novo dispensation of laxatives or anti-diarrheal drugs) gastrointestinal events. RESULTS: A total of 4723 CKD patients initiated SPS in Sweden and 90% of all users had stages 4,5 or underwent hemodialysis. Whereas 40% of SPS users only took one dispensation, 11%, 32% and 17% followed per label, occasional and sporadic chronic regimens, respectively. Compared to 9446 matched controls, SPS users were younger, more often men, with a previous history of hyperkalemia and consuming ACEi/ARBs (P<0.05 for all). During follow-up, 232 severe and 2302 minor gastrointestinal events were recorded. Compared to controls, SPS users did not experience an increased risk of severe adverse events (adjusted HR 1.18; 95% CI 0.89-1.56), but were at 1.24 (1.13-1.36) higher risk of minor gastrointestinal events, mainly accounted by de novo dispensation of laxatives (1.32; 1.20-1.46). Separate dispensation patterns showed similar results to the main analysis. CONCLUSIONS: In advanced/ESKD, SPS is often used chronically and below recommended dosages. SPS use did not associate with the risk of severe GI complications, but was associated with a 30% higher rate of laxative dispensations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".