Introduction:
Hyperkalemia, is a common electrolyte disturbance in hospitalized patients, particularly those with underlying conditions such as chronic kidney disease (CKD), heart failure, and those receiving certain medications like renin-angiotensin-aldosterone system (RAAS) inhibitors. Severe hyperkalemia can lead to significant cardiac complications, including arrhythmias and cardiac arrest, necessitating prompt and effective management.
Traditional treatments for hyperkalemia include dietary potassium restriction, loop diuretics, sodium polystyrene sulfonate (SPS), and intravenous calcium and insulin with glucose. However, these treatments often have limitations such as delayed onset of action, gastrointestinal side effects, and inconsistent efficacy.
Sodium zirconium cyclosilicate (SZC) is a novel, non-absorbed, inorganic cation exchanger that selectively binds potassium ions in exchange for sodium and hydrogen ions throughout the gastrointestinal tract. This mechanism allows for rapid and sustained reduction in serum potassium levels.
Methods:
This retrospective, single-center observational cohort study aimed to evaluate the efficacy and safety of sodium zirconium cyclosilicate (SZC) in reducing serum potassium levels in hospitalized CKD patients diagnosed with hyperkalemia. The primary objective was to determine the effectiveness of SZC in lowering potassium levels, while the secondary objectives focused on assessing the time required to achieve normalization of these levels and safety of SZC.
The study used data from electronic medical records (EMRs) of patients over an 18-month period, spanning from January 2023 to June 2024. The study population included CKD patients who were hospitalized with hyperkalemia and received SZC during their stay.
Results:
Fifty one patients with mean age 65.9±18.6 years, were treated with SZC (10g every 8 hours for 48 hours after admission). In addition to SZC, the standard treatment for management of hyperkalemia with correction of metabolic acidosis, salbutamol nebulizers, and calcium gluconate infusion was administered as appropriate during admission. Twenty four patients have received angiotensin converting enzyme inhibitors or angiotensin receptor blockers and nine patients have received potassium sparing diuretics before admission as part of their chronic medications. Patients included CKD stage 1 (n=5), CKD stage 2 (n=4), CKD stage 3 (n=9), CKD stage 4 (n=14) and CKD stage 5 (n=19). Serum potassium level decreased from 6.2 ±0.68 mmol/L on admission to 4.9±0.64 mmol/L after 24 hours and to 4.6±0.62 mmol/L after 48 hours respectively. Normal Serum potassium level (<5mmol/L) was achieved within 24 hours in 58.8% of patients and within 48 hours in 74.5% respectively. Adverse events or oedema were not observed; serum sodium and blood pressure remained stable.
Conclusions:
SZC was safe and effective for management of acute hyperkalemia in chronic kidney disease patients during their hospital admission.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.