Heart failure & cardiomyopathiesCohort study
Cardiovascular outcomes with potassium binders in patients with heart failure and hyperkalaemia
- retrospective observational study
- TriNetX network
- Three pairwise 1:1 propensity-matched comparisons
Authors' conclusion
In this observational study of HF with hyperkalaemia, potassium binders were associated with different cardiovascular outcomes. These findings are hypothesis-generating and support randomized trials powered for clinical endpoints.
Study context
- Population
- Adults with heart failure (HF) and hyperkalaemia initiating patiromer, sodium zirconium cyclosilicate (SZC), or sodium polystyrene sulfonate (SPS) (2019–2024)matched patients per group in each pairwise comparison · patiromer vs SPS, per group 5,589 · SZC vs SPS, per group 15,769 · SZC vs patiromer, per group 4,381
- Exposure
- cardiovascular outcomes associated with patiromer, sodium zirconium cyclosilicate (SZC), and sodium polystyrene sulfonate (SPS)
Main finding
As reported in the abstract
Patiromer vs SPS: HF hospitalization, cardiovascular hospitalization, mortality · Follow-up up to 365 days (mean 0.7 ± 0.4 years)
patiromer vs SPSHazard ratio (95% CI)
HF hospitalization
0.573(0.535–0.613)
cardiovascular hospitalization
0.737(0.697–0.779)
mortality (slightly higher)
1.096(1.027–1.170)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · death · propensity-matched | 1.139 (1.095–1.185) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · HF hospitalization · propensity-matched | 1.184 (1.143–1.225) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · myocardial infarction · propensity-matched | 1.132 (1.018–1.260) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · ESKD · propensity-matched | 1.137 (1.082–1.196) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · cardiovascular hospitalization · propensity-matched | 1.193 (1.157–1.229) | |
| SZC vs patiromer: HF hospitalization, cardiovascular hospitalization, mortality — SZC vs patiromer · HF hospitalization · propensity-matched | 2.735 (2.519–2.969) | |
| SZC vs patiromer: HF hospitalization, cardiovascular hospitalization, mortality — SZC vs patiromer · cardiovascular hospitalization · propensity-matched | 1.914 (1.797–2.037) | |
| 0.20.5125Hazard ratio (log scale) |
SZC vs patiromer: HF hospitalization, cardiovascular hospitalization, mortality
- no significant difference in mortality
Original publication
Cardiovascular outcomes with potassium binders in patients with heart failure and hyperkalaemia. ESC Heart Fail. Published 28 September 2026. doi:10.1093/eschf/xvag248
Summarised from the published abstract; every number is checked against it