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Abstract: PO1445

Post-Discharge Outcomes Among Hyperkalemic Patients Treated with and Without Sodium Polystyrene Sulfonate in the Inpatient Setting

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

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

Authors

  • Davis, Jill, AstraZeneca, Wilmington, Delaware, United States
  • Israni, Rubeen K., AstraZeneca, Wilmington, Delaware, United States
  • Cook, Erin, Analysis Group, Boston, Massachusetts, United States
  • Mu, Fan, Analysis Group, Boston, Massachusetts, United States
  • Betts, Keith, Analysis Group, Boston, Massachusetts, United States
  • Anzalone, Deborah A., AstraZeneca, Wilmington, Delaware, United States
  • Billmyer, Emma, Analysis Group, Boston, Massachusetts, United States
  • Lemus Wirtz, Esteban J., Analysis Group, Boston, Massachusetts, United States
  • Yin, Lei, Analysis Group, Boston, Massachusetts, United States
  • Szerlip, Harold M., Baylor University Medical Center, Dallas, Texas, United States
  • Uwaifo, Gabriel I., Oschner Medical Center, New Orleans, Louisiana, United States
  • Fonseca, Vivian A., Tulane University Medical Center; Tulane University School of Medicine, New Orleans, Louisiana, United States
Background

Sodium polystyrene sulfonate (SPS) is a common treatment option for hyperkalemia (HK) in the inpatient (IP) setting. However, the post-discharge outcomes of patients with HK treated with and without SPS in the IP setting are not well characterized.

Methods

Adult patients with ≥1 IP stay with HK (≥1 potassium [K] lab >5.0 mEq/L) were identified using electronic medical record data from the Research Action for Health Network (2012-2018). Patients treated with SPS during the IP stay were matched 1:1 to patients not treated with SPS on discharge status (dead/alive) and HK severity (most severe K lab during IP stay). Patient characteristics, K levels, HK treatments, length of stay (LOS) and death during IP stay were described. All-cause and HK-related IP readmission, and HK recurrence (in any setting) within 30, 60 and 90 days post-discharge were described and compared using conditional logistic regressions.

Results

A total of 4,847 SPS users were matched to non-SPS users (23.2% K>5.0-5.5, 36.8% >5.5-6.0, 40.0% >6.0 mEq/L). During the stay, 11.7% of patients died in both cohorts. Mean age was 65.7 and 62.1 years for the SPS and non-SPS users. SPS users had a higher burden of comorbidities than non-SPS users, including CKD (79.1% v 57.2%) and heart failure (49.8% v 37.7%; both p<0.001). The average LOS was similar for SPS and non-SPS users (9.0 v 9.1 days) and most patients had their last K level normalized (≤5.0 mEq/L) during the stay (83.0% v 86.2%, p<0.001). Use of temporizing agents was common for SPS and non-SPS users (58.2% v 43.5%, p<0.001); however, very few SPS users received SPS at discharge (0.4%). The 30-day all-cause and HK-related IP readmission rates were 27.0% and 13.6% for SPS users and 19.3% and 5.4% for non-SPS users, respectively. HK recurred within 30 days in 23.0% of SPS users and 7.1% of non-SPS users. The differences remained after adjusting for baseline and IP stay characteristics (odds ratio [95% CI]: all-cause readmission=1.4 [1.2, 1.6]; HK readmission=2.4 [2.0, 2.9]; HK recurrence=3.1 [2.7, 3.6]). The adjusted results were similar for 60 and 90 days post-discharge.

Conclusion

Despite treatment with SPS in the IP setting there was a high burden of readmission and HK recurrence among patients with HK.

Funding

  • Commercial Support