Atiquzzaman Mohammad, Birks Peter, Bevilacqua Micheli, Wong Michelle M Y, Zheng Yuyan, Djurdjev Ognjenka, Levin Adeera
BC Renal, Vancouver, Canada.
Division of Nephrology, The University of British Columbia, Vancouver, Canada.
Can J Kidney Health Dis. 2022 Nov 15;9:20543581221137177. doi: 10.1177/20543581221137177. eCollection 2022.
Little was known about how chronic hyperkalemia (cHK) in patients with chronic kidney disease (CKD) is managed in British Columbia, Canada.
To investigate the trend in sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) utilization and their efficacy in treating cHK in CKD patients from British Columbia, Canada.
Retrospective cohort.
SETTING & PATIENTS: CKD patients aged ≥18 years, followed in Kidney Care Clinic (KCC), who had at least 2 potassium values ≥5.0 mmol/L separated by no more than 91 days during the period of June 1, 2015, to July 31, 2021, were included. Index date was the first date of the 2 potassium values ≥5.0 mmol/L. Patients who received SPS or CPS within 90 days before index date were excluded. Patients who were on dialysis or received kidney transplantation on or before index date were also excluded.
Continuous exposure to SPS and CPS.
SPS/CPS prescription utilization trend was described by the proportion of patients ever treated with SPS/CPS, median time in days between cHK diagnosis and initiating treatment with SPS/CPS, total and median number of SPS/CPS prescriptions dispensed. Change in mean serum potassium concentration before and after a 90-day continuous treatment with SPS/CPS was estimated.
Descriptive.
This study included 10 495 patients with cHK (median age 74 years, 60% were male). Median follow-up time was 625 days. Only 2864 (27%) patients were dispensed at least 1 prescription of either SPS or CPS. A total 7300 prescriptions were dispensed; median prescriptions dispensed per patients were 2 (interquartile range [IQR]: 1-3). Median time from index date to the first prescription dispensing date was 154 days (IQR: 36-455). Continuous 90-day treatment with SPS/CPS decreased the mean serum potassium concentration by 0.60 mmol/L, from 5.58 to 4.98 mmol/L.
Descriptive observational study without control group.
In British Columbia, only 1 in 4 CKD patients with cHK were dispensed with SPS/CPS, mostly with higher degrees of hyperkalemia. These medications appeared to be moderately effective in reducing the serum potassium concentration. Future research is necessary to evaluate the comparative effectiveness of newer generation medications.
在加拿大不列颠哥伦比亚省，慢性肾病（CKD）患者的慢性高钾血症（cHK）治疗情况鲜为人知。
调查聚苯乙烯磺酸钠（SPS）和聚苯乙烯磺酸钙（CPS）在加拿大不列颠哥伦比亚省CKD患者中治疗cHK的使用趋势及其疗效。
回顾性队列研究。
纳入2015年6月1日至2021年7月31日期间在肾脏护理诊所（KCC）随访的年龄≥18岁的CKD患者，这些患者至少有2次血钾值≥5.0 mmol/L，间隔不超过91天。索引日期为2次血钾值≥5.0 mmol/L的首次日期。排除索引日期前90天内接受过SPS或CPS治疗的患者。排除索引日期当日或之前接受透析或接受肾脏移植的患者。
持续暴露于SPS和CPS。
用接受过SPS/CPS治疗的患者比例、cHK诊断至开始使用SPS/CPS治疗的中位天数、SPS/CPS处方总数量及中位数量来描述SPS/CPS处方使用趋势。估计SPS/CPS持续治疗90天前后平均血清钾浓度的变化。
描述性分析。
本研究纳入了10495例cHK患者（中位年龄74岁，60%为男性）。中位随访时间为625天。只有2864例（27%）患者至少开具了1张SPS或CPS处方。共开具了7300张处方；每位患者的中位处方数为2张（四分位间距[IQR]：1 - 3）。从索引日期到首次处方开具日期的中位时间为154天（IQR：36 - 455）。SPS/CPS持续治疗90天使平均血清钾浓度从5.58 mmol/L降至4.98 mmol/L，降低了0.60 mmol/L。
无对照组的描述性观察性研究。
在不列颠哥伦比亚省，每4例cHK的CKD患者中只有1例使用了SPS/CPS，大多数患者高钾血症程度较高。这些药物在降低血清钾浓度方面似乎有一定疗效。有必要开展进一步研究以评估新一代药物的相对疗效。
