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Abstract: PO1135

Risk of Heart Failure in Patients Who Initiated Sodium Zirconium Cyclosilicate vs. Patiromer

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

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

Authors

  • Zhuo, Min, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Kim, Seoyoung C., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Patorno, Elisabetta, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Desai, Rishi J., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Paik, Julie M., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
Background

Hyperkalemia is common in patients with chronic kidney disease (CKD), heart failure, and diabetes. Sodium zirconium cyclosilicate (SZC) and patiromer were recently approved for the treatment of hyperkalemia. Since SZC contains significant amounts of sodium, we assessed the risk of heart failure hospitalization (HHF) associated with the initiation of SZC versus patiromer in non-dialysis patients.

Methods

We used a U.S. commercial insurance claims database (Optum Clinformatics® Data Mart) between May 2018 (after SZC approval) and September 2020. Participants were non-dialysis adults who had ≥ 180 days of insurance enrollment and were newly prescribed SZC or patiromer. The primary outcome was a hospitalization with a discharge diagnosis of heart failure. The secondary outcome was a hospitalization or an emergency room visit with a diagnosis of any edema. Propensity score (PS) matching in a variable ratio up to 1:3 was used to adjust for more than 80 variables, including demographic characteristics, comorbidities, medication use, and health care utilization. Cox proportional hazards regression models were used to generate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

Our cohort included 1,126 SZC initiators and 2,839 PS-matched patiromer initiators (total N=3,965). The mean age was 72 (±10) years, 30% had a history of heart failure and 85% had CKD stages 3-5. The risk of HHF was higher in the SZC initiators compared to patiromer initiators (HR 1.22, 95%CI 0.95-1.56), but the confidence interval included the null value (Table). Edema was more common in the SZC initiators (HR 1.89, 95%CI 1.05-3.39). In subgroup analyses, initiation of SZC was associated with an increased risk of HHF (HR 1.58, 95%CI 1.01-2.46) amongst patients without a history of heart failure.

Conclusion

Patients initiating SZC may need to monitor volume status and consider dietary salt restrictions and initiation or adjustment of diuretics. Larger studies are needed to more precisely evaluate the safety of SZC in routine practice.

Number of events, incidence rate (IR)*, rate difference (RD)*, and HRs before and after PS-matching
 Before PS-matchingAfter PS-matching
OutcomeSZC
N=1,265
Patiromer
N=3,388
RD (95% CI)HR (95% CI)SZC
N=1,126
Patiromer
N=2,839
RD (95% CI)HR (95% CI)
HHF, N (IR)97 (35.0)309 (26.5)8.6 (1.0, 16.1)1.32 (1.05, 1.66)88 (35.8)245 (25.1)10.7 (2.6, 18.9)1.22 (0.95, 1.56)
Edema, N (IR)21 (7.3)43 (3.5)3.8 (5.0, 7.1)2.08 (1.24, 3.51)18 (7.1)35 (3.4)3.6 (1.7, 7.1)1.89 (1.05, 3.39)

*In 100 person-years