Abstract: PO0849
Fatal and Non-Fatal Gastrointestinal Events with Sodium Polystyrene Sulfonate Use in Hemodialysis: DOPPS
Session Information
- Fluid, Electrolytes, and Clinical Events with Dialysis: Getting to the "Heart" of the Matter
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Farfan Ruiz, Ana Cecilia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Knoll, Greg A., University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Rhodes, Emily, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Sood, Manish M., University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
Background
There are increasing concerns regarding the gastrointestinal (GI) safety of sodium polystyrene sulfonate (SPS), a medication commonly used in the management of hyperkalemia.
The objective is to compare the risk for fatal, non-fatal and their composite GI events following initiation of SPS in patients on hemodialysis compared to non-use
Methods
An international registry of adults (≥18) on chronic intermittent hemodialysis (Dialysis Outcomes and Practice Patterns Study, DOPPS, Phases 2-6 from 2002 to 2018, 17 countries, n=229,295) who were prescribed SPS (n=24,668, 10.76%) were compared with non-users of SPS. Individual patient and facility-level analysis of fatal and non-fatal GI events were examined using weighted models.
Results
Country-level variation in SPS use ranged from 0.74% (UK) to 47.42% (France). 934 fatal, and 837 non-fatal events occurred [3-year cumulative incidence for fatal GI events: SPS 9.0% vs. no SPS 7.6%; non-fatal: SPS 0.4% vs. non-use 0.5%]. The weighted risk of fatal and composite GI events was elevated with SPS use compared to non-use (fatal HR 1.18 95%CI 1.05-1.32, non-fatal HR 0.73 95%CI 0.64-0.84, composite HR 1.02 95%CI 0.82-1.26). Younger age (<=65), men, country (France, Belgium, Japan), dialysis vintage (>4 years), shorter HD treatment time (<3.5 hours) and a higher K gradient (serum potassium – dialysate potassium) were associated with a higher risk of a fatal GI event with SPS. The findings were consistent when limited to individuals with known vascular access (n=135, 628) and in an analysis examining the fraction of SPS use by facility.
Conclusion
SPS use in patients on hemodialysis is associated with a higher risk of fatal GI events.
Funding
- Private Foundation Support