{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:06:03Z","timestamp":1787238363380,"version":"build-2736575974"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This observational cohort study compared the likelihood of maintained (stabilized\/up-titrated) renin\u2013angiotensin\u2013aldosterone system inhibitor (RAASi) therapy at 6\u00a0months following hyperkalaemia in patients with chronic kidney disease (CKD) and\/or heart failure (HF) from the USA, Japan and Spain who received sodium zirconium cyclosilicate (SZC) for at least 120\u00a0days, relative to those with no prescription for a potassium (K+) binder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using health registers and hospital medical records, patients with CKD and\/or HF receiving RAASi therapy who experienced a hyperkalaemia episode were identified. Propensity score (PS) matching (1:4) was applied to balance the SZC cohort to the no K+ binder cohort on baseline characteristics. Logistic regression analysis was performed to compare the odds of maintained RAASi therapy at 6\u00a0months in the SZC versus no K+ binder cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The PS-matched SZC cohort included 565 (USA), 776 (Japan) and 56 (Spain) patients; the no K+ binder cohort included 2068, 2629 and 203 patients, respectively. At 6\u00a0months, 68.9% (USA), 79.9% (Japan) and 69.6% (Spain) in the SZC cohorts versus 53.1% (USA), 56.0% (Japan) and 48.3% (Spain) in the no K+ binder cohorts had maintained RAASi therapy. Meta-analysed across countries, the odds ratio of maintained RAASi therapy in the SZC cohort versus no K+ binder cohort was 2.56 (95% confidence interval 1.92\u20133.41; P\u00a0&amp;lt;\u00a0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In routine clinical practice across three countries, patients treated with SZC were substantially more likely to maintain guideline-concordant RAASi therapy at 6\u00a0months following hyperkalaemia relative to patients with no K+ binder treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfae083","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T12:01:30Z","timestamp":1711108890000},"source":"Crossref","is-referenced-by-count":22,"title":["Maintained renin\u2013angiotensin\u2013aldosterone system inhibitor therapy with sodium zirconium cyclosilicate following a hyperkalaemia episode: a multicountry cohort study"],"prefix":"10.1093","volume":"17","author":[{"given":"Anjay","family":"Rastogi","sequence":"first","affiliation":[{"name":"Department of Medicine, David Geffen School of Medicine, University of California Los Angeles , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Charles V","family":"Pollack","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Mississippi School of Medicine , Jackson, MS , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio Jos\u00e9","family":"S\u00e1nchez L\u00e1zaro","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitari i Polit\u00e8cnic La Fe , Valencia , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Les\u00e9n","sequence":"additional","affiliation":[{"name":"BioPharmaceuticals Medical CVRM Evidence, AstraZeneca , Gothenburg , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Arnold","sequence":"additional","affiliation":[{"name":"Real World Science and Digital, AstraZeneca , Cambridge , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Franz\u00e9n","sequence":"additional","affiliation":[{"name":"Medical & Payer Evidence Statistics, AstraZeneca , Gothenburg , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaster","family":"Allum","sequence":"additional","affiliation":[{"name":"BioPharmaceuticals Medical CVRM, AstraZeneca , Cambridge , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Atrys Health , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toyoaki","family":"Murohara","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nagoya University Graduate School of Medicine , Nagoya , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichiro","family":"Kanda","sequence":"additional","affiliation":[{"name":"Department of Medical Science, Kawasaki Medical School , Okayama , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,25]]},"reference":[{"key":"2024050111301321700_bib1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur J Heart Fail"},{"issue":"3 Suppl","key":"2024050111301321700_bib2","first-page":"S1","article-title":"KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease","volume":"99","author":"Kidney Disease: Improving Global Outcomes Blood Pressure Work Group","year":"2021","journal-title":"Kidney Int"},{"issue":"5 Suppl","key":"2024050111301321700_bib3","first-page":"S1","article-title":"KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease","volume":"102","author":"Kidney Disease: Improving Global Outcomes Diabetes Work Group","year":"2022","journal-title":"Kidney Int"},{"key":"2024050111301321700_bib4","doi-asserted-by":"crossref","first-page":"465","DOI":"10.5414\/CNP62465","article-title":"Hyperkalemia-induced ECG abnormalities in patients with reduced renal function","volume":"62","author":"Esposito","year":"2004","journal-title":"Clin Nephrol"},{"key":"2024050111301321700_bib5","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1159\/000437151","article-title":"Serum potassium, end-stage renal disease and mortality in chronic kidney disease","volume":"41","author":"Nakhoul","year":"2015","journal-title":"Am J Nephrol"},{"key":"2024050111301321700_bib6","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jemermed.2004.04.006","article-title":"Electrocardiographic manifestations: electrolyte abnormalities","volume":"27","author":"Diercks","year":"2004","journal-title":"J Emerg Med"},{"key":"2024050111301321700_bib7","doi-asserted-by":"crossref","first-page":"e156","DOI":"10.1111\/j.1755-5922.2010.00258.x","article-title":"Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers","volume":"30","author":"Raebel","year":"2012","journal-title":"Cardiovasc Ther"},{"key":"2024050111301321700_bib8","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1001\/jamainternmed.2013.12700","article-title":"Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia","volume":"174","author":"Hsu","year":"2014","journal-title":"JAMA Intern Med"},{"key":"2024050111301321700_bib9","doi-asserted-by":"crossref","first-page":"5828","DOI":"10.3390\/jcm11195828","article-title":"Risk\u2013benefit balance of renin\u2013angiotensin\u2013aldosterone inhibitor cessation in heart failure patients with hyperkalemia","volume":"11","author":"Kohsaka","year":"2022","journal-title":"J Clin Med"},{"key":"2024050111301321700_bib10","doi-asserted-by":"crossref","first-page":"n189","DOI":"10.1136\/bmj.n189","article-title":"Association between antihypertensive treatment and adverse events: systematic review and meta-analysis","volume":"372","author":"Albasri","year":"2021","journal-title":"BMJ"},{"key":"2024050111301321700_bib11","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1016\/j.ekir.2019.05.018","article-title":"Hyperkalemia in real-world patients under continuous medical care in Japan","volume":"4","author":"Kashihara","year":"2019","journal-title":"Kidney Int Rep"},{"key":"2024050111301321700_bib12","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2215\/CJN.12990820","article-title":"Ambulatory treatments for RAAS inhibitor-related hyperkalemia and the 1-year risk of recurrence","volume":"16","author":"Hundemer","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"key":"2024050111301321700_bib13","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1093\/ndt\/gfz263","article-title":"Risk of hyperkalemia from renin\u2013angiotensin\u2013aldosterone system inhibitors and factors associated with treatment discontinuities in a real-world population","volume":"36","author":"Wetmore","year":"2021","journal-title":"Nephrol Dial Transplant"},{"key":"2024050111301321700_bib14","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12882-022-03054-5","article-title":"Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia","volume":"24","author":"Kanda","year":"2023","journal-title":"BMC Nephrol"},{"issue":"11 Suppl","key":"2024050111301321700_bib15","first-page":"S212","article-title":"Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors","volume":"21","author":"Epstein","year":"2015","journal-title":"Am J Manag Care"},{"key":"2024050111301321700_bib16","doi-asserted-by":"crossref","first-page":"e012655","DOI":"10.1161\/JAHA.119.012655","article-title":"Real-world associations of renin\u2013angiotensin\u2013aldosterone system inhibitor dose, hyperkalemia, and adverse clinical outcomes in a cohort of patients with new-onset chronic kidney disease or heart failure in the United Kingdom","volume":"8","author":"Linde","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2024050111301321700_bib17","first-page":"e263","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume-title":"J Am Coll Cardiol","author":"Heidenreich","year":"2022"},{"key":"2024050111301321700_bib18","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1002\/ejhf.2612","article-title":"An international Delphi consensus regarding best practice recommendations for hyperkalaemia across the cardiorenal spectrum","volume":"24","author":"Burton","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2024050111301321700_bib19","author":"US Food and Drug Administration"},{"key":"2024050111301321700_bib20","author":"US Food and Drug Administration"},{"key":"2024050111301321700_bib21","doi-asserted-by":"crossref","first-page":"798","DOI":"10.2215\/CJN.12651018","article-title":"Sodium zirconium cyclosilicate among individuals with hyperkalemia: a 12-month phase 3 study","volume":"14","author":"Spinowitz","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"2024050111301321700_bib22","doi-asserted-by":"crossref","first-page":"2886","DOI":"10.1007\/s12325-023-02518-w","article-title":"Real-world modifications of renin-angiotensin-aldosterone system inhibitors in patients with hyperkalemia initiating sodium zirconium cyclosilicate therapy: the OPTIMIZE I study","volume":"40","author":"Agiro","year":"2023","journal-title":"Adv Ther"},{"key":"2024050111301321700_bib23","doi-asserted-by":"crossref","first-page":"e016581","DOI":"10.1161\/JAHA.120.016581","article-title":"Resource utilization in the first 2 years following operative correction for tetralogy of Fallot: study using data from the Optum's de-identified Clinformatics Data Mart insurance claims database","volume":"9","author":"O'Byrne","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2024050111301321700_bib24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s40801-022-00296-5","article-title":"Context and considerations for use of two Japanese real-world databases in Japan: Medical Data Vision and Japanese Medical Data Center","volume":"9","author":"Laurent","year":"2022","journal-title":"Drugs Real World Outcomes"},{"key":"2024050111301321700_bib25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.recesp.2020.09.014","article-title":"Epidemiology and treatment of heart failure in Spain: the HF-PATHWAYS study","volume":"75","author":"Sicras-Mainar","year":"2022","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"2024050111301321700_bib26","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1053\/j.ajkd.2022.01.002","article-title":"Hyperkalemia-related discontinuation of renin-angiotensin-aldosterone system inhibitors and clinical outcomes in CKD: a population-based cohort study","volume":"80","author":"Leon","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"2024050111301321700_bib27","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/ehf2.12244","article-title":"Mineralocorticoid receptor antagonists for heart failure: a real-life observational study","volume":"5","author":"Bruno","year":"2018","journal-title":"ESC Heart Fail"},{"key":"2024050111301321700_bib28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000520909","article-title":"Heart failure in patients with diabetes and chronic kidney disease: challenges and opportunities","volume":"12","author":"Vijay","year":"2021","journal-title":"Cardiorenal Med"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfae083\/57318993\/sfae083.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/17\/5\/sfae083\/57366505\/sfae083.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/17\/5\/sfae083\/57366505\/sfae083.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T07:30:36Z","timestamp":1714548636000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfae083\/7634359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,25]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfae083","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5]]},"published":{"date-parts":[[2024,3,25]]},"article-number":"sfae083"}}