Outcomes and Resource Utilization in Hyperkalemic Emergency Department Patients Treated With Patiromer or Sodium Zirconium Cyclosilicate.

OBJECTIVES

Hyperkalemia (HK) is a life-threatening condition commonly treated in emergency department (ED). Real-world outcomes associated with ED administration of potassium binders are limited. This study assessed ED discharge disposition and resource utilization in hyperkalemic ED patients treated with patiromer or sodium zirconium cyclosilicate (SZC).

METHODS

We performed a retrospective cohort study using discharge data from 230 hospitals in the Premier PINC AI Healthcare Database. ED patients were included if they were ≥18 years old, had potassium ≥5 mEq/L, and received patiromer/SZC during January 1, 2019 to December 31, 2021. Descriptive statistics and multivariable logistic regression analysis were used to compare outcomes between binder cohorts.

RESULTS

Of 18,248 patients meeting selection criteria, 6480 and 11,768 received patiromer and SZC, respectively. Compared with patients receiving SZC, patients receiving patiromer were older, more likely to be White and Hispanic, with Medicare as primary insurance, and had a higher mean Charlson-Deyo Comorbidity Index. Adjusted analysis showed that the odds of being admitted to an inpatient ward were similar between cohorts (adjusted odds ratio [aOR] = 1.09; 95% CI: 0.96, 1.23). Patients receiving patiromer had lower mortality during index visit (12.0% vs 16.3%; aOR = 0.85; 95% CI: 0.76, 0.95), but higher odds of all-cause hospitalization (3.0% vs 0.8%; aOR = 3.54; 95% CI: 2.73, 4.59) and hyperkalemia-related hospitalization (1.1% vs 0.3%; aOR = 3.28; 95% CI: 2.15, 5.00) during 30-day follow-up than patients receiving SZC.

CONCLUSION

This large nationally representative sample of US ED patients showed that patiromer and SZC treatment had similar discharge dispositions to inpatient ward/home. Patients receiving patiromer had lower in-hospital mortality. Patients receiving SZC had lower 30-day all-cause and hyperkalemia-related hospitalization risks.