Evidence map›Paper›PMID 40531443›Full record

ArticleAdvances in therapy2025

Renin-Angiotensin-Aldosterone System Inhibitor Dosing After Initiation of Outpatient Sodium Zirconium Cyclosilicate Therapy: The GALVANIZE RAASi Real-World Evidence Study.

Abiy Agiro, Ali Greatsinger, Fan Mu, Erin E Cook, Jingyi Chen, Manasvi Sundar, Angela Zhao, Ellen Colman, Arun Malhotra

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Article in Advances in therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Abiy AgiroUS Medical Affairs, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA. abiy.agiro@astrazeneca.com.
Ali GreatsingerAnalysis Group, Inc., 151 W 42nd Street, 23rd Floor, New York, NY, 10036, USA.
Fan MuAnalysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA, 02199, USA.
Erin E CookAnalysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA, 02199, USA.
Jingyi ChenAnalysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA, 02199, USA.
Manasvi SundarAnalysis Group, Inc., 333 S Hope St # 27, Los Angeles, CA, 90071, USA.
Angela ZhaoAnalysis Group, Inc., 111 Huntington Ave, 14th Floor, Boston, MA, 02199, USA.
Ellen ColmanAstraZeneca, 121 Seaport Blvd, Boston, MA, 02210, USA.
Arun MalhotraUS Medical Affairs, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe use of renin-angiotensin-aldosterone system inhibitors (RAASi), including mineralocorticoid receptor antagonists (MRAs), can cause or exacerbate hyperkalemia, especially in patients with chronic kidney disease (CKD) and heart failure (HF). Prior research has demonstrated that sodium zirconium cyclosilicate (SZC) can enable continued RAASi use in patients with hyperkalemia. This study, GALVANIZE RAASi, sought to describe the proportion of patients with hyperkalemia who had an optimized or maximized RAASi dose after the initiation of outpatient SZC therapy.

methodsUsing data from a large US insurance claims database from July 2018-December 2022, adults initiating SZC in the outpatient setting (index) while using a RAASi (≥ 7 day overlap with index and ≥ 1 RAASi fill in the 6-month follow-up period) were selected. Sub-studies included patients with baseline diagnosis codes for CKD or HF and patients with ≥ 1 MRA prescription during follow-up. The proportion of patients with an optimized (≥ 50% of target dose) or maximized (≥ 100% of target dose) RAASi dose during follow-up was described.

resultsOf the 2973 patients meeting study inclusion criteria who were included in the overall sample, 2549 were included in the CKD sub-study, 879 in the HF sub-study and 395 in the MRA sub-study. In the overall sample, 63.7% of patients had an optimized RAASi dose and 27.2% of patients had a maximized RAASi dose during follow-up, and the results were similar across sub-studies (optimized RAASi dose: 62.9-72.6%; maximized RAASi dose: 26.9-36.1%).

conclusionIn this real-world study of patients with RAASi use after SZC initiation, about two-thirds of patients had an optimized RAASi dose and more than a quarter of patients had a maximized RAASi dose within 6 months of starting SZC. Findings were consistent across sub-studies of patients with CKD, HF and treatment with MRA. SZC may support the maintenance of optimal RAASi therapy; however, further comparative analyses are warranted. Graphical abstract available for this article.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHeart FailureHyperkalemiaMineralocorticoid Receptor AntagonistsRenal Insufficiency, ChronicSilicatesAdultAgedFemaleHumansMaleMiddle AgedRenin-Angiotensin SystemAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsMineralocorticoid Receptor AntagonistsSilicatessodium zirconium cyclosilicateChronic kidney diseaseHeart failureHyperkalemiaMineralocorticoid receptor antagonistsOptimized doseReal-world evidenceRenin-angiotensin-aldosterone system inhibitorsSodium zirconium cyclosilicate

Identifiers

PMID40531443
PMCPMC12313742

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.