AI-Enabled ECG Stratification and Timing of Potassium-Lowering Therapy in Patients With Hyperkalemia: A Target Trial Emulation Study

Sponsor
National Defense Medical Center, Taiwan
Study ID
NCT07307729
Status
Not Yet Recruiting

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Conditions

Eligibility Criteria

Sex
ALL
Age
18 Years - N/A
Healthy Volunteers
Not accepted

Interventions

  • Timely treatment — BEHAVIORAL
    Initiation of any potassium-lowering intervention within 1 hour of the index potassium measurement
  • Delayed treatment — BEHAVIORAL
    Initiation of any potassium-lowering intervention in 1 to 4 hours of the index potassium measurement.

Study Details

Hyperkalemia is a common and potentially life-threatening electrolyte disorder, yet there is limited evidence guiding the optimal timing of potassium-lowering therapy in routine clinical practice. Although electrocardiographic (ECG) abnormalities are recommended to inform treatment decisions, such findings are often subtle and difficult to recognize consistently by clinicians. This study aims to emulate a target trial to evaluate the association between the timing of potassium-lowering therapy (timely versus delayed initiation) and short-term mortality among patients with laboratory-confirmed hyperkalemia presenting to the emergency department. In addition, the study examines whether artificial intelligence-enabled ECG (AI-ECG) stratification identifies patient subgroups that may differentially benefit from earlier treatment. Using observational electronic health record data from multiple healthcare systems, including publicly available critical care databases and institutionally governed hospital datasets, treatment strategies are compared using causal inference methods designed to approximate randomized assignment. The primary outcome is 90-day all-cause mortality. The results of this study are intended to inform clinical decision-making regarding treatment timing in hyperkalemia and to evaluate the potential role of AI-ECG as a risk stratification tool in real-world settings.

Key Dates

Start date
Jan 1, 2026
Status verified
Dec 2025
Primary completion
Mar 31, 2026
Completion
Mar 31, 2026

Study Design

Enrollment
5,000 participants (estimated)
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT

Arms

  • Experimental: Timely treatment
    Initiation of any potassium-lowering intervention within one hour of the index potassium measurement
  • Experimental: Delayed treatment
    Initiation of any potassium-lowering intervention in 1 to 4 hours of the index potassium measurement

Primary Outcome Measure

All-cause mortality [ Time Frame: 90 days ]

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