Why carry out this study?

Hyperkalemia (HK) may disrupt optimal use of renin-angiotensin-aldosterone system inhibitors (RAASi), thereby reducing their therapeutic benefits.

Since RAASi are a cornerstone therapy for chronic kidney disease (CKD) and other conditions such as heart failure and hypertension, it is important that patients can maintain their RAASi medications even after experiencing HK; that said, there are scant data beyond the clinical trial setting that characterizes RAASi modification after sodium zirconium cyclosilicate (SZC) treatment.

What did the study ask?

To address this knowledge gap, the authors sought to use administrative claims data to describe RAASi modification among patients treated with SZC to manage HK in the outpatient setting, including RAASi optimization (i.e., % of patients who maintained the same dosage or who had an up-titration), non-optimization (i.e., % of patients who discontinued or who had a down-titration), and persistence (i.e., duration of time on treatment).

What was learned from the study?

Consistent with clinical trial findings, this real-world study found that the majority of patients who initiated SZC for HK optimized their RAASi therapy (77.4%); similar results were observed among subgroups with different risk factors and underlying conditions, including those without end-stage renal disease, with CKD, and with CKD + diabetes.

Among the patients who optimized RAASi after SZC initiation, 73.9% were still on RAASi therapy at 1-year post-index (median time to discontinuation: not reached), whereas 17.9% of patients who did not optimize RAASi after SZC initiation were still on therapy at 1-year post-index (median 46.0 days to discontinuation).

Predictors of successful optimization of RAASi therapy at follow-up included fewer prior hospitalizations (odds ratio = 0.79, p < 0.05) and fewer prior emergency department (ED) visits (0.78; p < 0.05), indicating that patients may require long-term SZC therapy to encourage the use of ongoing RAASi therapy especially after hospitalization or ED visits.