Sodium zirconium cyclosilicate treatment and rates of emergency interventions for hyperkalaemia: a propensity-score weighted case-control study.

IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2024-10-21 eCollection Date: 2024-11-01 DOI:10.1093/ckj/sfae313
William R Marshall, Gabriel A Curran, Jamie P Traynor, Keith A Gillis, Patrick B Mark, Jennifer S Lees
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引用次数: 0

Abstract

Background: Sodium zirconium cyclosilicate (SZC) reduces serum potassium in patients with chronic hyperkalaemia in clinical trials, but its role in the emergency treatment of hyperkalaemia is unproven. We hypothesized that SZC use for emergent hyperkalaemia would be associated with a reduction in rates of emergency interventions for hyperkalaemia.

Methods: This was a single-centre, propensity score-weighted case-control study of patients admitted with hyperkalaemia to a specialist renal centre. We randomly selected 250 patients admitted between April 2021 and September 2022 (post-SZC era) with a potassium level ≥5.5 mmol/l treated with at least one ≥10 g dose of SZC (treatment group). We randomly selected a comparator group of 250 patients admitted between January 2018 and December 2019 (pre-SZC era) with a potassium level ≥5.5 mmol/l (control group). Baseline demographic and clinical characteristics were recorded and used as covariates for propensity scoring and inverse probability treatment weighting (IPTW). Our primary outcome measure, rates of emergency haemodialysis (HD), was tested using unadjusted models and multivariable logistic regression models on unweighted data in addition to unadjusted models on weighted data. We also reviewed rates of emergency temporary central venous access as a secondary outcome.

Results: A total of 59% were male, the mean age was 67 years (standard deviation 14) and 149 (30%) were receiving maintenance dialysis. IPTW achieved satisfactory balance of covariates between the treatment and control groups. In the treatment group, patients were 77% less likely to need emergency HD {odds ratio [OR] 0.23 [confidence interval (CI) 0.17-0.31]}. This result was consistent following analysis of weighted and unweighted data. Similarly, patients treated with SZC were 73% less likely to require emergency temporary central venous access [OR 0.27 (CI 0.20-0.36)].

Conclusion: SZC was associated with a significant reduction in the rates of emergency HD and emergency temporary central venous access in patients admitted to a specialized renal centre with emergent hyperkalaemia.

高钾血症的环硅酸锆钠治疗和紧急干预率:倾向评分加权病例对照研究
背景:在临床试验中,环硅酸锆钠(SZC)可降低慢性高钾血症患者的血钾,但其在高钾血症急诊治疗中的作用尚未得到证实。我们假设SZC用于紧急高钾血症将与高钾血症紧急干预率的降低有关。方法:这是一项单中心、倾向评分加权的病例对照研究,研究对象是一家专科肾脏中心收治的高钾血症患者。我们随机选择了250名在2021年4月至2022年9月(后SZC时代)入院的患者,他们的钾水平≥5.5 mmol/l,至少接受了一次≥10g剂量的SZC治疗(治疗组)。我们随机选择了250名在2018年1月至2019年12月(szc前时代)入院的钾水平≥5.5 mmol/l的患者作为对照组。记录基线人口统计学和临床特征,并将其作为倾向评分和逆概率治疗加权(IPTW)的协变量。我们的主要结局指标,紧急血液透析率(HD),除了使用加权数据的未调整模型外,还使用未调整模型和多变量logistic回归模型对未加权数据进行了检验。我们也回顾了紧急临时中心静脉通路作为次要结果的比率。结果:男性59%,平均年龄67岁(标准差14),接受维持性透析149例(30%)。IPTW在治疗组和对照组之间取得了令人满意的协变量平衡。在治疗组中,患者需要紧急HD的可能性降低了77%{比值比[OR] 0.23[置信区间(CI) 0.17-0.31]}。在对加权和未加权数据进行分析后,结果是一致的。同样,接受SZC治疗的患者需要紧急临时中心静脉通路的可能性降低73% [OR 0.27 (CI 0.20-0.36)]。结论:SZC与急诊肾中心急诊高钾血症患者急诊HD和急诊临时中心静脉通路的发生率显著降低有关。
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来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
期刊介绍: About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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