Ambulatory Treatments for RAAS Inhibitor-Related Hyperkalemia and the 1-Year Risk of Recurrence
Bibliographic record
Abstract
Background: Hyperkalemia commonly occurs with RAAS inhibitor (RAASi) use. The effectiveness of common outpatient interventions in preventing recurrent hyperkalemia has never been directly compared. Methods: Population-based, retrospective cohort study of Ontario (Canada) residents ≥66 years old on RAASi therapy with ≥1 outpatient hyperkalemia (≥5.3 mmol/L) measurements between 2007-16. RAASi included ACE inhibitors, ARBs, MR antagonists, and ENaC inhibitors. Patients were included if they had one of the following interventions performed within 30 days of the hyperkalemia measurement: a) RAASi discontinuation, b) RAASi dose decrease, c) new K+ wasting diuretic prescription, d) K+ wasting diuretic dose increase, or e) sodium polystyrene sulfonate [SPS] prescription. The primary outcome was recurrence of hyperkalemia within 1 year. Secondary outcomes included major adverse cardiovascular events (MACE) and all-cause mortality within 1 year. Multivariable Fine and Gray sub-distribution models accounting for the competing risk of death were used for recurrent hyperkalemia and MACE outcomes. Multivariable Cox proportional hazards models were used for the all-cause mortality outcome. Results: A total of 21,723 patients were included: RAASi discontinuation (N=13,539), RAASi decrease (N=5,075), new diuretic (N=1,010), diuretic increase (N=1,245), and SPS (N=854). RAASi discontinuation was associated with a lower risk for recurrent hyperkalemia and MACE over 1 year compared with other common hyperkalemia interventions (see Figure). However, there was no clear difference in 1-year all-cause mortality among these interventions. Conclusions: RAASi discontinuation is associated with a lower 1-year risk for recurrent hyperkalemia and MACE compared with other common ambulatory interventions for hyperkalemia.
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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 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.002 |
| 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".