Treating Hyperkalemia With SPS Does not Reduce Hyperkalemia Recurrence

Sodium polystyrene sulfonate (SPS) is a common treatment option for hyperkalemia (HK) in the inpatient (IP) setting. However, the post-discharge outcomes of patients with HK treated with and without SPS in the IP setting are not well characterized. For the same, Dr Vivian A. Fonseca and his team conducted a study with 4847 SPS users matched to 4847 SPS nonusers with the same hyperkalemia severity.

The researchers identified adult patients with ≥1 IP stay with HK (≥1 potassium [K] lab >5.0 mEq/L) using electronic medical record data from the Research Action for Health Network (2012-2018). They evaluated patient characteristics, K levels, HK treatments, length of stay (LOS) and death during IP stay. They also assessed all-cause and HK-related IP readmission and HK recurrence (in any setting) within 30, 60 and 90 days post-discharge and compared it using conditional logistic regressions.

Key findings of the study were:

• The researchers identified 11.7% death in both cohorts.
• Upon evaluation, they found that SPS users had a higher burden of comorbidities than non-SPS users, including CKD (79.1% v 57.2%) and heart failure (49.8% v 37.7%).
• They observed a similar length of stay in both groups (9.0 v 9.1 days) and noted that most patients had their last K level normalized (≤5.0 mEq/L) during the stay (83.0% v 86.2%).
• They found that SPS users had significant 1.5-, 2.8-, and 3.6-fold increased odds of all-cause readmission, hyperkalemia readmission, and hyperkalemia recurrence, respectively, within 90 days of discharge.
• They noted that the use of temporizing agents such as albuterol, intravenous calcium, or intravenous insulin and glucose was common for both SPS and non-SPS users (58.2% v 43.5%); however, very few SPS users received SPS at discharge (0.4%).
• The 30-day all-cause and HK-related IP readmission rates were 27.0% and 13.6% for SPS users and 19.3% and 5.4% for non-SPS users, respectively.
• They noted that the HK recurred within 30 days in 23.0% of SPS users and 7.1% of non-SPS users.
• They found that SPS users had significant 2.4, 1.4 and, 3.1 fold increased odds of hyperkalemia readmission, all-cause readmission and HK recurrence within 30 days of discharge.

The authors concluded, "Despite treatment with SPS in the IP setting there was a high burden of readmission and HK recurrence among patients with HK."

For further information:

https://www.asn-online.org/education/kidneyweek/2020/program-abstract.aspx?controlId=3437213