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Abstract: PO1133

Real-World RAAS Inhibitor Use and Its Predictors Among Patients Initiating Sodium Zirconium Cyclosilicate

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

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


  • Agiro, Abiy, AstraZeneca, Wilmington, Delaware, United States
  • Amin, Alpesh, University of California Irvine, Irvine, California, United States
  • Mu, Fan, Analysis Group Inc., Boston, Massachusetts, United States
  • Young, Joshua A., Analysis Group Inc., Boston, Massachusetts, United States
  • Cook, Erin, Analysis Group Inc., Boston, Massachusetts, United States
  • Lemus Wirtz, Esteban J., Analysis Group Inc., Boston, Massachusetts, United States
  • Brahmbhatt, Yasmin G., AstraZeneca, Wilmington, Delaware, United States
  • Betts, Keith A., Analysis Group Inc., Boston, Massachusetts, United States
  • Pollack, Charles V., University of Mississippi School of Medicine, Jackson, Mississippi, United States

Renin-angiotensin-aldosterone system inhibitors (RAASi) are associated with reduced risk of death and slower disease progression in patients with heart failure (HF) and chronic kidney disease (CKD). However, RAASi use increases the risk of hyperkalemia (HK), which may disrupt RAASi use and mitigate its benefits. There is limited real-world evidence characterizing RAASi use after sodium zirconium cyclosilicate (SZC) treatment.


Adult patients initiating SZC (index date) while on a RAASi in outpatient care were included from a large US claims database (January 2018-June 2020). Analyses were conducted among all patients, patients with CKD and patients with CKD + diabetes (DM). The percent of patients with a RAASi prescription after index was summarized. Characteristics among patients with and without a new RAASi fill were compared using descriptive statistics. A multivariable logistic regression model assessed predictors of a new RAASi fill.


A total of 589 patients initiating SZC while on a RAASi were included (mean age 61 years, 65.2% male). Overall, 82.7% of patients had a new RAASi fill after index. The median time to discontinuation was not reached among patients with a new RAASi fill, of whom 88.1% at day 180 and 74.0% at 1 year remained on RAASi therapy. Median time on RAASi was 29 days (95% CI [27-43 days]) for those with no new RAASi fill. Compared to patients without a new RAASi fill, patients with a new fill had a higher burden of CKD (69.4% vs 58.8%) but a similar prevalence of DM (70.6% vs 67.6%) and HF (24.6% vs 28.4%). Results were similar in the CKD cohort (N=398; 84.9% had a new RAASi fill) and CKD and DM cohort (N=311; 85.2% had a new fill). Predictors of having a new RAASi fill included fewer prior hospitalizations (0.77 [0.60-0.98]; p<0.05) and emergency department (ED) visits (0.78 [0.63-0.97]; p<0.05).


In a real-world setting, 83% of patients had a new RAASi fill within 90 days after ending their index RAASi. Results are consistent with clinical trial finding and similar among patients with CKD and patients with CKD + DM. Patients with hospital and ED visits will require follow up care to encourage RAASi continuation.


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