Hospital and Emergency Department Utilization in U.S. Veterans with Hyperkalemia

Background: Patiromer (PAT) is a sodium-free, non-absorbed potassium (K+) binder (KB) approved for the treatment of hyperkalemia (HK). HK is common in older pts with cardiorenal comorbidities and often leads to increased Healthcare Resource Utilization (HRU). Here we aim to describe electrolyte-related HRU in Veterans with HK who initiated PAT or discontinued RAAS inhibitor (RAASi DC) therapy and were not receiving a KB (1/1/2016−8/30/2018). Methods: Using retrospective, observational data, pts utilizing the hospital or ED during the 6 months (mos) prior to the index date were assessed at 1, 3, and 6 mos post-index. The index date was the date of PAT initiation or the date of RAASi DC in pts not receiving a KB (RAASi DC/no KB). All pts had a baseline serum K+ ≥5.1mEq/L and HF, DM, or non-dialysis CKD. Pts with continuous exposure (CE) to PAT and those who did not restart RAASi were analyzed. Results: 288 and 26,543 pts were included in the PAT and RAASi DC/no KB groups, respectively. Following CE to PAT at 1, 3, and 6 mos post-index, no electrolyte related ED or hospital utilization was observed. In the RAASi DC group, 2-5% of pts reutilized the ED or hospital within 6 mos (Figure). Conclusion: Of the pts who experienced an electrolyte-related hospitalization or ED visit within the 6 mos prior to PAT dispensing, no pts reutilized these services in the following 6 mos. Given the limited number of PAT users, additional investigation is warranted. Disclosure: C.P. Kovesdy: Consultant;Self;Amgen, AstraZeneca, Bayer AG, Cara Therapeutics, Reata, Takeda Pharmaceutical Company Limited, Tricida. E. Gosmanova: None. S.D. Woods: Employee;Self;Relypsa, Inc. Stock/Shareholder;Self;Vifor Pharma Group. J.J. Fogli: Employee;Self;Relypsa, Inc. Stock/Shareholder;Self;Vifor Pharma Group. C.G. Rowan: Consultant;Self;AbbVie Inc., Covidia, Halozyme, Keryx, Relypsa, Inc., Vifor Pharma Group. Other Relationship;Self;COHRDATA. J.L. Hansen: Research Support;Self;COHRDATA. B.C. Sauer: Research Support;Self;COHRDATA. Funding: Relypsa, Inc. [ABSTRACT FROM AUTHOR] Copyright of Diabetes is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States.

National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID-19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. We used a binomial generalized linear model (log-binomial model) to examine the association of SOT status with death and other clinical outcomes. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non-SOT patients (40% and 43%, respectively; relative risk [RR] 0.92; 95% confidence interval [CI]: 0.70-1.22). Other outcomes and requirement for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups. There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR [95% CI]: 1.34 [0.97-1.85]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.