#1802 Treatment with potassium binders in central Sweden—an observational study based on the DEMONSTRATE database

Abstract Background and Aims Hyperkalemia (HK), defined as a plasma potassium level (> 5.0 mmol/L), is associated with adverse outcomes, including cardiac arrhythmias and mortality. Until recently, HK was managed mainly with sodium polystyrene sulfonate (SPS) (first generation potassium binders) but concerns regarding the safety profile warranted new alternatives. The second-generation potassium binders, patiromer and sodium zirconium cyclosilicate (SZC) were introduced in Sweden in 2018 and 2019 respectively. The aim of this observational study was to understand the current use of new potassium binders, the related potassium values triggering treatment and to describe the clinical characteristics of patients treated with first- and second-generation potassium binders (SPS and patiromer/SZC respectively) in Sweden. Method An observational study based on laboratory data from six regions in central Sweden (18% of the Swedish population), linked to national health registry data, comprising information on clinical events and pharmacy drug dispensations. All treatment episodes of potassium binders between 01 July 2005 and 31 December 2022 were selected and restricted to patients with information on potassium values. A new treatment episode was defined as a gap of at least 120 days to the prior pharmacy dispensations of potassium binders. We analyzed potassium values (up to 60 days prior to initiation of potassium binders), demographics, comorbidities and treatments. Results are mainly presented by treatment episodes and strata of; (a) all, (b) first- and (c) second-generation potassium binders. Results In total, we identified 13 441 treatment episodes of which 13 218 episodes (n = 7086 individuals), were attributed to first generation potassium binders (throughout the study period) and 223 episodes (n = 151 individuals) to second-generation potassium binders (from 2018-2022) (Table 1). Baseline characteristics are presented by treatment episodes. Baseline potassium value prior to treatment was 5.6 (0.8) mmol/L for first and 5.6 (0.7) for second generation potassium binders. Mean eGFR prior to treatment was 22.3 (16.3) ml/min/1.73 m2 for first and 18.7 (16.0) for second-generation potassium binders. Compared to first generation, second-generation potassium binders were prescribed to patients with more comorbidities (41.7% vs 32.1% for heart failure, 88.3% vs 81.7% for hypertension, and 39.5% vs 28.9% for dialysis) and more frequently from cardiology/internal medicine units (41.7% vs 30.0%). Distribution of potassium levels at baseline is shown in Fig. 1. Conclusion Compared to first- generation potassium binder, we observed fewer treatment episodes with second generation potassium binders, of which majority had a more severe comorbidity profile. There was no difference in potassium values prior to treatment between first- and second-generation potassium-binders.