背景:REVOLUTIONIZEI研究旨在描述在真实世界临床实践中接受3-4期慢性肾脏病(CKD)和高钾血症患者的医学营养治疗(MNT)与高钾血症复发之间的关系。
方法:这项观察性队列研究使用了来自年龄≥18岁的3-4期CKD患者的去识别电子健康记录数据,这些患者在2019年1月至2022年10月期间接受了MNT,并且在MNT前30天内患有高钾血症(血清钾>5.0mmol/L)。患者随访6个月或直到第一次审查事件(死亡,门诊钾粘合剂的处方,或研究结束)。主要结果是随访期间复发≥1次高钾血症患者的百分比。次要结局包括每位患者高钾血症复发次数,每次复发的时间,和高钾血症相关的医疗资源利用。探索性结果包括全因医疗保健资源利用和死亡率。
结果:最终队列包括2048名患者;6个月后1503名(73.4%)患者仍未检查。在6个月的随访期间,56.0%的患者在第一个月内复发≥1次高钾血症,37.4%的患者在第一个月内复发≥1次。随访期间复发≥1次高钾血症的患者的平均复发±标准差(SD)为2.6±2.2。首次高钾血症复发的平均±SD时间为45±46天;复发之间的时间随着随后的发作而减少。与高钾血症相关的住院和急诊就诊记录分别为13.7%和1.5%的患者,分别。敏感性分析显示,不同患者亚组的结果是一致的,包括合并心力衰竭患者和基线时接受肾素-血管紧张素-醛固酮系统抑制剂治疗的患者.
结论:大多数3-4期CKD患者有高钾血症复发,仅MNT不足以预防复发。这些患者可能需要额外的长期治疗,如新型钾粘合剂,维持正常钾血症并防止MNT后高钾血症复发。可用于本文的信息图。不清楚.
慢性肾脏病(CKD)患者通常接受注册营养师的饮食咨询,被称为医学营养疗法,帮助他们降低CKD并发症的风险,同时满足他们的特定营养需求。CKD患者血钾水平升高(高钾血症)的风险增加,这可能会危及生命。虽然医学营养治疗可以帮助高钾血症患者控制他们的饮食钾摄入量,其预防复发的效果尚不清楚.我们的目的是确定在现实世界临床实践中,非透析依赖性(3-4期)CKD患者的初始事件后,医学营养治疗是否可以帮助预防高钾血症复发。我们使用来自去识别的电子健康记录的数据来研究3-4期CKD患者在经历高钾血症后30天内接受医学营养治疗的6个月内的高钾血症复发。超过一半的患者(56.0%)在医学营养治疗后6个月内平均45天内至少有一次高钾血症复发;这些患者在6个月内平均有2.6次明显复发。在两次或两次以上高钾血症复发的患者中,这些之间的时间变得短于30天。我们的现实研究结果表明,高钾血症是一种慢性,3-4期CKD患者的复发情况,医学营养疗法不足以防止其复发。这表明这些患者可能需要额外的长期治疗高钾血症,如新型钾结合剂疗法,防止高钾血症复发。
BACKGROUND: The REVOLUTIONIZE I study aimed to characterize the relationships between medical nutrition therapy (MNT) and hyperkalemia recurrence in patients with stage 3-4 chronic kidney disease (CKD) and hyperkalemia who received MNT in real-world clinical practice.
METHODS: This observational cohort study used de-identified electronic health record data from patients aged ≥ 18 years with stage 3-4 CKD who received MNT between January 2019 and October 2022 and had hyperkalemia (serum potassium > 5.0 mmol/L) within 30 days before MNT. Patients were followed for 6 months or until the first censoring event (death, prescription of outpatient potassium binder, or study end). The primary outcome was the percentage of patients with ≥ 1 hyperkalemia recurrence during follow-up. Secondary outcomes included the number of hyperkalemia recurrences per patient, time to each recurrence, and hyperkalemia-related healthcare resource utilization. Exploratory outcomes included all-cause healthcare resource utilization and mortality.
RESULTS: The final cohort comprised 2048 patients; 1503 (73.4%) patients remained uncensored after 6 months. During the 6-month follow-up period, 56.0% of patients had ≥ 1 hyperkalemia recurrence and 37.4% had ≥ 1 recurrence within the first month. Patients with ≥ 1 hyperkalemia recurrence during follow-up had a mean ± standard deviation (SD) of 2.6 ± 2.2 recurrences. The mean ± SD time to first hyperkalemia recurrence was 45 ± 46 days; the time between recurrences decreased with subsequent episodes. Hyperkalemia-related hospitalizations and emergency department visits were recorded for 13.7% and 1.5% of patients, respectively. Sensitivity analyses showed that results were consistent across patient subgroups, including those with comorbid heart failure and patients receiving renin-angiotensin-aldosterone system inhibitor therapy at baseline.
CONCLUSIONS: Most patients with stage 3-4 CKD had hyperkalemia recurrence, and MNT alone was inadequate to prevent recurrence. These patients may require additional long-term treatment, such as novel potassium binders, to maintain normokalemia and prevent hyperkalemia recurrence following MNT. Infographic available for this article. INFOGRAPHIC.
Patients with chronic kidney disease (CKD) typically receive dietary counseling from a registered dietician, referred to as medical nutrition therapy, to help reduce their risk of complications of CKD while addressing their specific nutritional needs. Patients with CKD have an increased risk of elevated blood potassium levels (hyperkalemia), which has potentially life-threatening consequences. Although medical nutrition therapy may help patients with hyperkalemia to manage their dietary potassium intake, its effects in preventing recurrence are unclear. Our aim was to determine whether medical nutrition therapy can help prevent hyperkalemia recurrence after an initial event in patients with non-dialysis-dependent (stage 3–4) CKD in real-world clinical practice. We used data from de-identified electronic health records to study hyperkalemia recurrence over 6 months in patients with stage 3–4 CKD who received medical nutrition therapy within 30 days after experiencing hyperkalemia. Over half of the patients (56.0%) had at least one hyperkalemia recurrence within an average of 45 days during the 6 months after medical nutrition therapy; these patients had an average of 2.6 distinct recurrences in 6 months. In patients with two or more hyperkalemia recurrences, the time between these became shorter than 30 days. Our real-world study results show that hyperkalemia is a chronic, recurring condition in patients with stage 3–4 CKD, and that medical nutrition therapy is not enough to prevent its recurrence. This suggests that these patients may need additional long-term treatment for hyperkalemia, such as novel potassium binder therapy, to prevent hyperkalemia recurrence.