Peacock William Frank, Rafique Zubaid, Gayle Julie, Neuenschwander James, Brown Harold, Kammerer Jennifer, Budden Jeffrey, Rosenthal Ning
Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
PINC AI Applied Sciences, Premier Inc, Charlotte, North Carolina, USA.
J Am Coll Emerg Physicians Open. 2025 May 10;6(4):100158. doi: 10.1016/j.acepjo.2025.100158. eCollection 2025 Aug.
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).
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.
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.
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.
高钾血症（HK）是一种危及生命的病症，常在急诊科（ED）进行治疗。关于急诊科给予钾结合剂的实际疗效的研究有限。本研究评估了接受帕替罗姆或环硅酸锆钠（SZC）治疗的高钾血症急诊患者的急诊出院处置情况和资源利用情况。
我们使用Premier PINC AI医疗数据库中230家医院的出院数据进行了一项回顾性队列研究。纳入的急诊患者年龄≥18岁，血钾≥5 mEq/L，且在2019年1月1日至2021年12月31日期间接受了帕替罗姆/SZC治疗。采用描述性统计和多变量逻辑回归分析来比较不同钾结合剂组的疗效。
在18248名符合入选标准的患者中，分别有6480名和11768名接受了帕替罗姆和SZC治疗。与接受SZC治疗的患者相比，接受帕替罗姆治疗的患者年龄更大，更可能是白人和西班牙裔，以医疗保险作为主要保险，且Charlson-Deyo合并症指数的平均得分更高。校正分析显示，两组患者入住 inpatient ward的几率相似（校正比值比[aOR]=1.09；95%置信区间：0.96，1.23）。接受帕替罗姆治疗的患者在首次就诊期间的死亡率较低（12.0%对16.3%；aOR = 0.85；95%置信区间：0.76，0.95），但在30天随访期间，全因住院几率（3.0%对0.8%；aOR = 3.54；95%置信区间：2.73，4.59）和高钾血症相关住院几率（1.1%对0.3%；aOR = 3.28；95%置信区间：2.15，5.00）高于接受SZC治疗的患者。
这项来自美国急诊患者的具有全国代表性的大样本研究表明，帕替罗姆和SZC治疗后的出院处置情况相似，即入住 inpatient ward/回家。接受帕替罗姆治疗的患者院内死亡率较低。接受SZC治疗的患者30天全因和高钾血症相关住院风险较低。
