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 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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".