Fatal and Non-Fatal Gastrointestinal Events with Sodium Polystyrene Sulfonate Use in Hemodialysis: DOPPS
Bibliographic record
Abstract
Background: There are increasing concerns regarding the gastrointestinal (GI) safety of sodium polystyrene sulfonate (SPS), a medication commonly used in the management of hyperkalemia. The objective is to compare the risk for fatal, non-fatal and their composite GI events following initiation of SPS in patients on hemodialysis compared to non-use Methods: An international registry of adults (≥18) on chronic intermittent hemodialysis (Dialysis Outcomes and Practice Patterns Study, DOPPS, Phases 2-6 from 2002 to 2018, 17 countries, n=229,295) who were prescribed SPS (n=24,668, 10.76%) were compared with non-users of SPS. Individual patient and facility-level analysis of fatal and non-fatal GI events were examined using weighted models. Results: Country-level variation in SPS use ranged from 0.74% (UK) to 47.42% (France). 934 fatal, and 837 non-fatal events occurred [3-year cumulative incidence for fatal GI events: SPS 9.0% vs. no SPS 7.6%; non-fatal: SPS 0.4% vs. non-use 0.5%]. The weighted risk of fatal and composite GI events was elevated with SPS use compared to non-use (fatal HR 1.18 95%CI 1.05-1.32, non-fatal HR 0.73 95%CI 0.64-0.84, composite HR 1.02 95%CI 0.82-1.26). Younger age (<=65), men, country (France, Belgium, Japan), dialysis vintage (>4 years), shorter HD treatment time (<3.5 hours) and a higher K gradient (serum potassium - dialysate potassium) were associated with a higher risk of a fatal GI event with SPS. The findings were consistent when limited to individuals with known vascular access (n=135, 628) and in an analysis examining the fraction of SPS use by facility. Conclusions: SPS use in patients on hemodialysis is associated with a higher risk of fatal GI events. Funding: Private Foundation Support
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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 | 0.000 | 0.000 |
| 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 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".