Journal Article

Intermittent sodium zirconium cyclosilicate for the prevention of hyperkalemia in chronic kidney disease

Chow, Kai-Ming, Szeto, Cheuk-Chun, Ng, Jack Kit-Chung, Chan, Gordon Chun-Kau, Fung, Winston Wing-Shing

2025

Overview

Background Hyperkalemia is a common complication of chronic kidney disease (CKD) that often requires urgent dialysis and increases healthcare costs. Daily sodium zirconium cyclosilicate (SZC) is a safe and effective treatment for the control of serum potassium levels in CKD patients. We studied the efficacy and safety of intermittent SZC therapy for the prevention of hyperkalemia in CKD patients. Methods In a retrospective study, we analyzed patients in the Hospital Authority Clinical Data Analysis and Reporting System (CDARS) receiving sodium zirconium cyclosilicate (Lokelma ® ) therapy once to thrice weekly for at least 3 months from January 2021 to June 2023. Outcome measures included plasma potassium levels, hyperkalemia episodes, hospital admissions, and renal function changes, which were compared to the 6 months period before the initiation of SZC treatment. Results We studied 36 adult CKD patients. SZC treatment significantly reduced plasma potassium levels from 5.10 (inter-quartile range [IQR] 4.91–5.40) to 4.73 (IQR 4.50–5.10) mmol/l ( p  = 0.0003). The median incidence of any hyperkalemia reduced from 5.0 (IQR 2.0–8.0) to 1.9 (IQR 0.0–4.7) episode per patient-year ( p  = 0.0001), and the incidence of urgent treatment for hyperkalemia decreased from 2.0 (IQR 0.0–4.0) to 0.0 (IQR 0.0–1.5) episode per patient-year ( p  = 0.007). The number of emergency room attendance and hospitalization were not significantly reduced. Conclusion Intermittent SZC treatment may help prevent hyperkalemia in CKD patients. Further research is necessary to ascertain if this benefit translates into improvements in hard clinical outcomes. Clinical trial number Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Analysis / Care and treatment / Chronic kidney failure / Dialysis / Emergency medical care / Emergency medical services / Female / Glucose / Hemodialysis / Hospitalization / Humans / Hyperkalemia / Hyperkalemia - blood / Hyperkalemia - etiology / Hyperkalemia - prevention & control / Information management / Insulin / Internal Medicine / Kidney diseases / Male / Medical care, Cost of / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Nephrology / Patient admissions / Patients / Peritoneal dialysis / Plasma / Potassium / Potassium - blood / Prevention / Renal failure / Renal function / Renal Insufficiency, Chronic - blood / Renal Insufficiency, Chronic - complications / Research ethics / Retrospective Studies / Silicates - administration & dosage / Silicates - therapeutic use / Sodium / Statistical analysis / Zirconium