A multicenter, prospective, observational study for the real-world treatment of hyperkalemia among patients in the emergency department in China (POETRY-E)

Background Hyperkalemia is a common and potentially lethal electrolyte disorder in the emergency department (ED). We aim to explore the real-world effectiveness of hyperkalemia treatment, and the patterns of hyperkalemia management in the ED in China. Methods POETRY-E (ChiCTR2100053100) was a multicenter, prospective, observational study. Adult patients with serum potassium (sK + ) ≥ 5.5 mmol/L admitted to the ED were enrolled from 15 centers across China and followed until discharge from the ED. The primary endpoint was the change in sK + from baseline to 6 h after treatment initiation. Secondary and exploratory endpoints included the clinical burden of hyperkalemia (e.g., severity, complications, survival, etc.), and the real-world management strategies of hyperkalemia in the ED. Results Between October 2021 and March 2023, 577 patients were enrolled. The median (Q1, Q3) baseline sK + was 6.25 (5.82, 6.83) mmol/L. At 6 h, after treatment initiation, the median (Q1, Q3) change in sK + from baseline was − 1.30 (− 1.96, − 0.72) mmol/L ( P < 0.001), with 46.4% ( n = 268) achieving sK + < 5.5 mmol/L. Most patients ( n = 457, 79.2%) received combination therapies, among which 36.1% ( n = 165) received oral potassium binders, predominantly sodium zirconium cyclosilicate (SZC) ( n = 152). The SZC-containing therapies were associated with a lower median (Q1, Q3) sK + at 4 h compared with non-SZC-containing regimens (5.20 [4.90, 5.70] vs. 5.81 [4.99, 6.10] mmol/L, P = 0.019) and a trend towards lower sK + at 6 h (4.98 [4.60, 5.50] vs. 5.20 [4.67, 5.70] mmol/L, P = 0.140). Moreover, the SZC-containing therapies were associated with numerically favorable median (Q1, Q3) change in sK + from baseline compared with non-SZC-containing regimens at 4 and 6 h (4 h: − 1.23 [− 1.65, − 0.70] vs. − 0.94 [− 1.42, − 0.55] mmol/L; 6 h: − 1.42 [− 1.98, − 0.90] vs. − 1.30 [− 1.90, − 0.73]). Death in the ED occurred in 24 (4.2%) patients. Conclusions In Chinese patients with hyperkalemia presented to the ED, hyperkalemia management was effective in rapidly reducing sK + . SZC-containing therapies may be more effective treatment options. Trial registration Chinese Clinical Trial Register (ChiCTR2100053100), registered on November 10, 2021.