APPETIZE: Palatability of and Preference for Potassium Binders in Patients With CKD and Hyperkalemia
Bibliographic record
Abstract
Background: Traditional K+ binders (PB) such as sodium and calcium polystyrene sulphonate (C/SPS), while not indicated for the chronic management of hyperkalemia (HK) are often believed to be unpalatable, poorly tolerated by patients, and associated with gastrointestinal side effects. Novel PB such as sodium zirconium cyclosilicate (SZC) and patiromer sorbitex calcium (CPaS) may be better tolerated; no published data exist for palatability, an important patient-centric endpoint. The primary study aim was to compare the patient-reported overall palatability of 3 currently available PB. Methods: APPETIZE (NCT04566653) was a cross-sectional, randomized crossover study evaluating the palatability of and patient preference for C/SPS, SZC, and CPaS. Participants with chronic kidney disease (CKD), documented HK, and no recent use of PB were randomized to one of six taste sequences, with a ‘sip and spit' taste test approach. Each PB was scored with respect to patient-centric attributes (taste, texture, smell, and mouthfeel) on a 0-10 scale, combined into an overall palatability composite score (0-40), and analyzed using linear mixed models. Patients were also asked to rank by palatability their first choice among the 3 PB. Further analyses of relevant factors are planned for the palatability of and emotional response to HK treatment options. Results: A total of 144 patients participated from the US (N=58), EU (France, Italy, and Spain, N=62), and Canada (N=24) including 77 (53%) dialysis-dependent and 67 (47%) non dialysis-dependent CKD patients; 12% had history of heart failure. Mean age was 66 y, 70% were male. Conclusions: In all regions palatability of SZC was superior to C/SPS and similar to CPaS, and patients ranked preference for SZC numerically higher than for the other products. These findings suggest that patients prefer newer PB, and this may improve compliance to long-term HK treatment. Funding: Commercial Support - AstraZenecaTable.: Palatability composite and preference ranking results
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".