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Abstract: PO1132

Metabolic Acidosis That Exists with Hyperkalemia (HK) Among Patients That Initialize Binder Therapy: The MAXIMIZE Study

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Kuranz, Seth P., TriNetX, LLC, Cambridge, Massachusetts, United States
  • Agiro, Abiy, AstraZeneca, Global Medical Affairs, Wilmington, Delaware, United States
  • Brzozowski, Kaylen, TriNetX, LLC, Cambridge, Massachusetts, United States
  • Pottorf, William, AstraZeneca, Global Medical Affairs, Wilmington, Delaware, United States
  • Landsman-Blumberg, Pamela B., TriNetX, LLC, Cambridge, Massachusetts, United States
  • Ix, Joachim H., University California San Diego, San Diego, California, United States
Background

Approximately 25% of chronic kidney disease (CKD) patients with serum potassium (sK+)>5.0 mEq/L may also have metabolic acidosis (MA). However, successful management of comorbid HK and MA in CKD patients is unclear. This real-world evidence study examines the association between patient characteristics and binder treatment among CKD patients with HK and MA.

Methods

This was a retrospective study of stage 3-5 CKD patients with HK (sK+>5.0 mmol/L) and MA (serum bicarbonate (sHCO3-) between 16-20 mmol/L) in a US EMR network of 64 million patients. The index event was the first qualifying sK+ result between 07/01/19 and 12/31/20. Baseline demographic and clinical characteristics were assessed among SZC, SPS, and NKB treated cohorts including age, sex, race, HK severity, sHCO3- level, visit type, and comorbidities. Logistic regression produced adjusted odds ratios (ORs) and 95% confidence intervals describing the association between baseline characteristics and treatment: sodium zirconium cyclosilicate (SZC) vs sodium polystyrene sulfonate (SPS) and SZC vs no potassium binder (NKB).

Results

Of the 32,113 patients who met study criteria 11.6% were treated with SZC (n=939) or SPS (n=2,774), 88.4% with NKB (n=28,400), and 11.1% with sodium HCO3- (n=3,572). Age and sex were similar among SZC, SPS, and NKB cohorts and 81%, 77%, and 70% had moderate-to-severe acidosis (sHCO3- <20mmol/L), respectively.

Baseline characteristics associated with increased odds of SZC vs SPS and SZC vs NKB treatment included sHCO3-<20mmol/L [OR=1.29 (1.03-1.61); OR=1.24(1.04-1.47)] and liver disease [OR=1.61(1.16-2.23); OR=1.47(1.14-1.89)], respectively. Treatment with SZC vs NKB treatment was more likely in inpatient settings [OR=3.73(3.06-4.55)] and in patients with comorbid congestive heart failure [OR=1.43 (1.12-1.84)].

Conclusion

Clinicians were more likely to treat HK with SZC than SPS or NKB in CKD patients with moderate-to-severe acidosis in a recent large, US, real-world sample. Secondary findings from prior clinical trials suggest that SZC may improve MA as well normalize sK+. Future clinical trials are needed to assess the impact of SZC on sHCO3- concentrations.

Funding

  • Commercial Support – Research funded by AstraZeneca