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Background <p>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.</p> Methods <p>POETRY-E (ChiCTR2100053100) was a multicenter, prospective, observational study. Adult patients with serum potassium (sK<sup>+</sup>) ≥ 5.5&#xa0;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<sup>+</sup> from baseline to 6&#xa0;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.</p> Results <p>Between October 2021 and March 2023, 577 patients were enrolled. The median (Q1, Q3) baseline sK<sup>+</sup> was 6.25 (5.82, 6.83) mmol/L. At 6&#xa0;h, after treatment initiation, the median (Q1, Q3) change in sK<sup>+</sup> from baseline was −&#xa0;1.30 (−&#xa0;1.96, −&#xa0;0.72) mmol/L (<i>P</i> &lt; 0.001), with 46.4% (<i>n</i> = 268) achieving sK<sup>+</sup>  &lt; 5.5&#xa0;mmol/L. Most patients (<i>n</i> = 457, 79.2%) received combination therapies, among which 36.1% (<i>n</i> = 165) received oral potassium binders, predominantly sodium zirconium cyclosilicate (SZC) (<i>n</i> = 152). The SZC-containing therapies were associated with a lower median (Q1, Q3) sK<sup>+</sup> at 4&#xa0;h compared with non-SZC-containing regimens (5.20 [4.90, 5.70] vs. 5.81 [4.99, 6.10] mmol/L, <i>P</i> = 0.019) and a trend towards lower sK<sup>+</sup> at 6&#xa0;h (4.98 [4.60, 5.50] vs. 5.20 [4.67, 5.70] mmol/L, <i>P</i> = 0.140). Moreover, the SZC-containing therapies were associated with numerically favorable median (Q1, Q3) change in sK<sup>+</sup> from baseline compared with non-SZC-containing regimens at 4 and 6&#xa0;h (4&#xa0;h: −&#xa0;1.23 [−&#xa0;1.65, −&#xa0;0.70] vs. −&#xa0;0.94 [−&#xa0;1.42, −&#xa0;0.55] mmol/L; 6&#xa0;h: −&#xa0;1.42 [−&#xa0;1.98, −&#xa0;0.90] vs. −&#xa0;1.30 [−&#xa0;1.90, −&#xa0;0.73]). Death in the ED occurred in 24 (4.2%) patients.</p> Conclusions <p>In Chinese patients with hyperkalemia presented to the ED, hyperkalemia management was effective in rapidly reducing sK<sup>+</sup>. SZC-containing therapies may be more effective treatment options.</p> <p><i>Trial registration</i> Chinese Clinical Trial Register (ChiCTR2100053100), registered on November 10, 2021.</p>

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

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  • 发表日期：

    2026年7月18日

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  • Yangyang Fu,
  • Yao Wu,
  • Yili Dai,
  • Hong Zhan,
  • Danni Li,
  • Guiyun Li,
  • Yuyang Qiu,
  • Laifa Kong,
  • Daoyuan Jing,
  • Yan Shi,
  • Ming Sun,
  • Chao Wu,
  • Fenshuang Zheng,
  • Wencao Liu,
  • Zhijun Zhao,
  • Ying Deng,
  • Junying Kong,
  • Changju Zhu,
  • Qiaofang Wang,
  • Yingying Hu,
  • Jianzhong Yang,
  • Dandan Li,
  • Yingping Tian,
  • Dongqi Yao,
  • Na Meng,
  • Mao Zhang,
  • Yueyang Chai,
  • Jian Guan,
  • Qijun Ou,
  • Kui Jin,
  • Huadong Zhu,
  • Xuezhong Yu,
  • Zhaoxing Tian,
  • Jun Xu

摘要

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.