#3664 EVALUATION OF THE INTRODUCTION OF NOVEL POTASSIUM BINDERS IN ROUTINE CARE: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT
Bibliographic record
Abstract
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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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| 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".