Managing Hyperkalemia With Sodium Zirconium Cyclosilicate

Patients with hyperkalemia may be treated with the potassium binder sodium zirconium cyclosilicate (SZC), a nonabsorbed nonpolymer zirconium silicate. Results of previous studies have shown that patients with hyperkalemia treated with SCZ have a higher rate of continuation of renin-angiotensin-aldosterone system (RAAS) inhibitors. However, according to Wakana Kimura, MD, and colleagues, there have been no studies on the effect of SCZ on continuation of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) in patients with hyperkalemia, compared with that of calcium polystyrene sulfonate (CPS). Results were reported in the Journal of Nephrology.

The researchers conducted a single-center, retrospective observational study that enrolled patients on ACE inhibitors or ARBs who were newly prescribed SCZ or CPS at a tertiary referral hospital between August 2020 and April 2022. The primary outcome measure was prescription for a ACE inhibitor or ARB 3 months following initiation of a potassium binder.

The total cohort included 174 patients on ACE inhibitor or ARB who were newly administered SCZ (n=62) or CPS (n=112). At 3 months following initiation of a potassium binder, the prescription rate of an ACE inhibitor or ARB was significantly higher in the SCZ group than in the CPS group (89% vs 72%, respectively).

In multivariable logistic regression models, there was am independent association between SCZ and the primary outcome of ACE inhibitor or ARB prescription (odds ratio, 2.66; 95% CI, 1.05-7.43). There was also a significant association between SCZ and the primary outcome in the propensity score-matched comparison.

In conclusion, the authors said, “Our study suggests that administering SCZ to patients with hyperkalemia allows for a higher continuation rate of ACE inhibitors or ARBs than CPS. These findings suggest that SCZ had potential benefits for patients with chronic kidney disease receiving RAAS inhibitors.”

Source: Journal of Nephrology