Marshall William R, Curran Gabriel A, Traynor Jamie P, Gillis Keith A, Mark Patrick B, Lees Jennifer S
School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
Glasgow Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.
Clin Kidney J. 2024 Oct 21;17(11):sfae313. doi: 10.1093/ckj/sfae313. eCollection 2024 Nov.
Sodium zirconium cyclosilicate (SZC) reduces serum potassium in patients with chronic hyperkalaemia in clinical trials, but its role in the emergency treatment of hyperkalaemia is unproven. We hypothesized that SZC use for emergent hyperkalaemia would be associated with a reduction in rates of emergency interventions for hyperkalaemia.
This was a single-centre, propensity score-weighted case-control study of patients admitted with hyperkalaemia to a specialist renal centre. We randomly selected 250 patients admitted between April 2021 and September 2022 (post-SZC era) with a potassium level ≥5.5 mmol/l treated with at least one ≥10 g dose of SZC (treatment group). We randomly selected a comparator group of 250 patients admitted between January 2018 and December 2019 (pre-SZC era) with a potassium level ≥5.5 mmol/l (control group). Baseline demographic and clinical characteristics were recorded and used as covariates for propensity scoring and inverse probability treatment weighting (IPTW). Our primary outcome measure, rates of emergency haemodialysis (HD), was tested using unadjusted models and multivariable logistic regression models on unweighted data in addition to unadjusted models on weighted data. We also reviewed rates of emergency temporary central venous access as a secondary outcome.
A total of 59% were male, the mean age was 67 years (standard deviation 14) and 149 (30%) were receiving maintenance dialysis. IPTW achieved satisfactory balance of covariates between the treatment and control groups. In the treatment group, patients were 77% less likely to need emergency HD {odds ratio [OR] 0.23 [confidence interval (CI) 0.17-0.31]}. This result was consistent following analysis of weighted and unweighted data. Similarly, patients treated with SZC were 73% less likely to require emergency temporary central venous access [OR 0.27 (CI 0.20-0.36)].
SZC was associated with a significant reduction in the rates of emergency HD and emergency temporary central venous access in patients admitted to a specialized renal centre with emergent hyperkalaemia.
在临床试验中，环硅酸锆钠（SZC）可降低慢性高钾血症患者的血清钾水平，但其在高钾血症急诊治疗中的作用尚未得到证实。我们推测，使用SZC治疗急性高钾血症将降低高钾血症急诊干预的发生率。
这是一项在专科肾脏中心进行的单中心、倾向评分加权病例对照研究，研究对象为因高钾血症入院的患者。我们随机选取了2021年4月至2022年9月（SZC时代后）入院的250例血钾水平≥5.5 mmol/L且接受至少一剂≥10 g SZC治疗的患者（治疗组）。我们随机选取了2018年1月至2019年12月（SZC时代前）入院的250例血钾水平≥5.5 mmol/L的患者作为对照组。记录基线人口统计学和临床特征，并将其用作倾向评分和逆概率治疗加权（IPTW）的协变量。我们的主要结局指标是急诊血液透析（HD）的发生率，除了对加权数据进行未调整模型分析外，还对未加权数据使用未调整模型和多变量逻辑回归模型进行检验。我们还将急诊临时中心静脉置管率作为次要结局指标进行了评估。
共有59%为男性，平均年龄为67岁（标准差14），149例（30%）正在接受维持性透析。IPTW使治疗组和对照组之间的协变量达到了满意的平衡。在治疗组中，患者需要急诊HD的可能性降低了77%{比值比[OR] 0.23 [置信区间（CI）0.17 - 0.31]}。对加权和未加权数据进行分析后，这一结果是一致的。同样，接受SZC治疗的患者需要急诊临时中心静脉置管的可能性降低了73%[OR 0.27（CI 0.20 - 0.36）]。
在因急性高钾血症入住专科肾脏中心的患者中，SZC与急诊HD率和急诊临时中心静脉置管率的显著降低相关。
