SZC for Hyperkalemia Management in Asian Hemodialysis Patients

The potassium binder sodium zirconium cyclosilicate (SZC) may be an option for the prevention or management of hyperkalemia in hemodialysis (HD) patients, but data regarding its safety and efficacy among Asian HD patients beyond phase 3 trials have been limited. Thus, Behram Khan reported on real-world use of SZC in a cohort of Asian HD patients at the International Society of Nephrology World Congress of Nephrology 2024.

A total of 293 patients who received maintenance HD at community-based dialysis centers in Singapore were the subject of a clinical audit. They received SZC for either prevention or management of hyperkalemia during anticipated interruptions to dialysis, such as when traveling.

Among those receiving treatment for hyperkalemia (n=147), serum potassium (K+) prior to starting SZC and at the end point were compared using a paired t test. Changes in K+ from baseline to end point were compared across different categories within each demographic and health-related variables using either a t test or one-way analysis of variance. Patients who had adverse events after starting SZC or were deceased during the audit were reviewed so that an informative account could be provided.

Among patients who received SZC for hyperkalemia treatment, use of SZC was associated with a significant reduction in serum potassium (0.812 mmol/L). Patients who were not of Chinese, Malay, or Indian ethnicity saw a nominal reduction in K+ of 0.7 mmol/L; the small sample size of this subgroup accounts for this. Individuals of Chinese, Malay, and Indian ethnicities represented more than 95% of the sample and showed a significant reduction in K+ levels (P<.001). Other studies of SZC demonstrated similar efficacy across ethnicities. Patients who received SZC for hyperkalemia treatment or prevention had a significantly reduced mortality rate. However, this reduction in mortality may have inherent biases and confounders, due to the retrospective clinical audit study design.

The efficacy of SZC in the real-world setting was similar to that found in previous trials. “Overall, SZC was safe and effective among the audited patients,” Khan concluded. “The novel use of SZC to manage serum potassium when HD sessions are missed, such as during traveling, warrants further investigation due to potentially significant life-saving implications.”

Source: KI Reports