The Association of Heart Failure and Edema Events between Patients Initiating SZC or Patiromer.

Abstract

Background: Sodium zirconium cyclosilicate (SZC) and patiromer (PAT) are potassium binders that differ by exchange ion, sodium, and calcium, respectively. There is limited data on whether using sodium exchange could impact the risks of hospitalizations for heart failure (HHF) or severe edema in patients with hyperkalemia.

Objectives: To assess the occurrence rates of pre-specified major encounters potentially related to electrolyte-/fluid-related imbalances (including HHF, edema) among new users of PAT or SZC.

Methods: Using Cerner Real World Data, we conducted a retrospective cohort study among adults (≥18 years) who were newly initiated on SZC or PAT between June 1, 2018, and December 31, 2021. Based on baseline demographic and clinical characteristics, 1 PAT initiator was propensity score matched with 2 SZC initiators. Primary outcomes were any HHF, primary HHF, major edema encounter (MEE), or death. Cox Proportional Hazard regression models were used to estimate the association between SZC or PAT use and each outcome in the overall population and subgroups with/without prior heart failure (HF).

Results: The final cohort included 9,929 PAT initiators matched to 19, 849 SZC initiators. Mean age was 66 years old; about 50% had a history of chronic kidney disease stages 3-5, and 34% a history of HF. Incidence rates (IR) were significantly higher in the SZC cohort when compared to the PAT cohort for all outcomes. Risks of HHF (any/primary) (adjusted Hazard ratios, HR: 1.373; 95% CI: 1.337-1.410), MEE (HR: 1.330; 95% CI: 1.298-1.363), and death (HR: 1.287; 95% CI: 1.255-1.320) were also significantly higher in the SZC cohort compared to the PAT cohort (p<0.05). These findings were consistent among subgroups with/without prior HF.

Conclusions: SZC use (vs. PAT) was associated with increased risk of pre-specified encounters potentially sodium-/fluid-related, including among patients with/without pre-existing HF.