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Yoo N, Song YB, Dubinsky I, Altshuler J. Single Dose of Sodium Zirconium Cyclosilicate Versus Sodium Polystyrene Sulfonate in Hospitalized Patients With Hyperkalemia. Ann Pharmacother 2023; 57:1044-1052. [PMID: 36637028 DOI: 10.1177/10600280221141918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Sodium zirconium cyclosilicate (SZC) is an inorganic zirconium silicate compound that selectively exchanges potassium for hydrogen and sodium. "Once" doses of SZC (with option to redose) in patients with hyperkalemia in hospitalized settings have not been evaluated. We hypothesized that a once dose of SZC would be non-inferior to sodium polystyrene sulfonate (SPS) in reducing serum potassium. OBJECTIVE The objective of our study is to evaluate the effect of a "once" dose of SZC when compared with SPS in reducing serum potassium levels. METHODS This was a retrospective analysis of patients who received either a "once" dose of SZC or single or repeated doses of SPS for hyperkalemia. The primary endpoint was mean absolute reduction in the first serum potassium value at least 4 hours after administration. The secondary efficacy endpoints were the rate of additional potassium-lowering therapies and the rate of normokalemia within 48 hours. Safety endpoints were the incidence of electrolyte abnormalities, hypoglycemia, hypertension, hypotension, and colonic necrosis. RESULTS A total of 260 patients were included in the analysis. The mean initial serum potassium was similar between groups (5.6 ± 0.4). The absolute serum potassium reduction was -0.88 ± 0.64 mEq/L and -0.75 ± 0.65 mEq/L with SZC and SPS, respectively. The "once" regimen of SZC demonstrated non-inferiority compared with SPS (P < 0.0001). The proportion of patients achieving normokalemia within 48 hours and the proportion of patients receiving additional potassium-lowering therapies did not differ between groups. CONCLUSION AND RELEVANCE The "once" dose regimen (with redose option) of SZC was non-inferior to the "once" or repeated dosing regimen of SPS with regard to absolute potassium reduction. There were no significant differences in the rate of additional potassium-lowering therapies and the rate of normokalemia at 48 hours. The incidence of hypertension was less common among patients who received SZC.
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Affiliation(s)
- Noah Yoo
- JFK University Medical Center, Hackensack Meridian Health, Edison, NJ, USA
| | - Yong-Bum Song
- JFK University Medical Center, Hackensack Meridian Health, Edison, NJ, USA
| | - Ilya Dubinsky
- JFK University Medical Center, Hackensack Meridian Health, Edison, NJ, USA
| | - Jerry Altshuler
- JFK University Medical Center, Hackensack Meridian Health, Edison, NJ, USA
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Shen N, Meng Q, Zhang L, Xie H, Zhao J, Xing C, Zuo L, Long G, Zhu Q, Shan C, Cai X, Yang J, Luo X, Wang J, Ye J, Wan X, Tian S, Wu Y, Lin Y, Yu X, Li Q, Liu X, Shi Z, Zhou J, Liu C, Cao Y, Wang N, Jiang X, Wu H, Hu Y, Li L, Wang Z, He J, Cao J, Wu F, Ma C, Yin X, Li Z, Wang H, Lin H. Evaluation of safety, effectiveness and treatment patterns of sodium zirconium cyclosilicate in management of hyperkalaemia in China: a real-world study protocol. BMJ Open 2023; 13:e070530. [PMID: 36889826 PMCID: PMC10008460 DOI: 10.1136/bmjopen-2022-070530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Hyperkalaemia (HK) is a potentially life-threatening electrolyte imbalance associated with several adverse clinical outcomes. The efficacy and negative effects of currently existing treatment options have made HK management questionable. Sodium zirconium cyclosilicate (SZC), a novel highly selective potassium binder, is approved for the treatment of HK. The present study will be aimed to assess the safety, effectiveness and treatment patterns of SZC in Chinese patients with HK in a real-world clinical setting as it is required by China's drug review and approval process. METHODS AND ANALYSIS This is a multicentre, prospective cohort study which plans to enrol 1000 patients taking SZC or willing to take SZC from approximately 40 sites in China. Patients ≥18 years of age at the time of signing the written informed consent and with documented serum potassium levels ≥5.0 mmol/L within 1 year before study enrolment day will be included. Eligible patients will receive SZC treatment and will be followed up for 6 months from enrolment day. The primary objective will be to evaluate the safety of SZC for the management of HK in Chinese patients in terms of adverse events (AEs), serious AEs as well as discontinuation of SZC. The secondary objectives will include understanding the SZC dosage information in terms of its effectiveness and treatment patterns under real-world clinical practice and assessing effectiveness of SZC during the observational period. ETHICS AND DISSEMINATION This study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Dalian Medical University (approval number: YJ-JG-YW-2020). All the participating sites have received the ethics approval. Results will be disseminated through national and international presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05271266.
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Affiliation(s)
- Nan Shen
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingyang Meng
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lihong Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hua Xie
- Department of Nephrology, Dalian Ruikaier Renal Disease Hospital, Dalian, China
| | - Jianrong Zhao
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Changying Xing
- Department of Nephrology, Jiangsu Province Official Hospital, Nanjing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Gang Long
- Department of Nephrology, Tianjin People's Hospital, Tianjin, China
| | - Qiang Zhu
- Department of Nephrology, Xinghua People's Hospital, Xinghua, China
| | - Chunyan Shan
- Department of Nephrology, Chu Hsien-I Memorial Hospital of Tianjin Medical University, Tianjin, China
| | - Xudong Cai
- Department of Nephrology, Ningbo Traditional Chinese Medicine Hospital, Ningbo, China
| | - Jing Yang
- Department of Nephrology, Hefei First People's Hospital, Hefei, China
| | - Xun Luo
- Department of Nephrology, Hunan Provincial People's Hospital, Changsha, China
| | - Jianmin Wang
- Department of Nephrology, Linfen Central Hospital, Linfen, China
| | - Jianming Ye
- Department of Nephrology, First People's Hospital of Kunshan, Kunshan, China
| | - Xin Wan
- Department of Nephrology, The First Hospital of Nanjing, Nanjing, China
| | - Shaojiang Tian
- Department of Nephrology, Shiyan People's Hospital, Shiyan, China
| | - Yifan Wu
- Department of Nephrology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yongqiang Lin
- Department of Nephrology, Wenzhou Integrated Chinese and Western Medicine Hospital, Wenzhou, China
| | - Xiaoyong Yu
- Department of Nephrology, Shanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Qing Li
- Department of Nephrology, Tianjin Teda Hospital, Tianjin, China
| | - Xinyu Liu
- Department of Nephrology, Nanyang Central Hospital, Nanyang, China
| | - Zhenwei Shi
- Department of Nephrology, The First Hospital of Tsinghua University, Beijing, China
| | - Jingwei Zhou
- Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chunyan Liu
- Department of Nephrology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanping Cao
- Department of Nephrology, Handan First Hospital, Handan, China
| | - Niansong Wang
- Department of Nephrology, The Sixth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Xinxin Jiang
- Department of Nephrology, Sandun District of Zhejiang Hospital, Hangzhou, China
| | - Henglan Wu
- Department of Nephrology, First Hospital of Jiaxing, Jiaxing, China
| | - Yao Hu
- Department of Nephrology, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, China
| | - Lu Li
- Department of Nephrology, Xi'an First Hospital Affiliated to Xi'an Medical University, Xi'an, China
| | - Zhaohua Wang
- Department of Nephrology, Taian City Central Hospital, Taian, China
| | - Jingdong He
- Department of Nephrology, Nuclear Industry 416 Hospital, Chengdu, China
| | - Juan Cao
- Department of Nephrology, Taixing People's Hospital, Taizhou, China
| | - Fenglei Wu
- Department of Nephrology, Qidong People's Hospital, Qidong, China
| | - Cong Ma
- Department of Nephrology, Anshan Central Hospital, Anshan, China
| | - Xun Yin
- Department of Nephrology, Changshu No 2 People's Hospital, Changshu, China
| | - Zhongxin Li
- Department of Nephrology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huimin Wang
- Department of Nephrology, Liaoning Health Industry Group Bensteel General Hospital, Liaoning, China
| | - Hongli Lin
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Larivée NL, Michaud JB, More KM, Wilson JA, Tennankore KK. Hyperkalemia: Prevalence, Predictors and Emerging Treatments. Cardiol Ther 2022; 12:35-63. [PMID: 36503972 PMCID: PMC9742042 DOI: 10.1007/s40119-022-00289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
It is well established that an elevated potassium level (hyperkalemia) is associated with a risk of adverse events including morbidity, mortality and healthcare system cost. Hyperkalemia is commonly encountered in many chronic conditions including kidney disease, diabetes and heart failure. Furthermore, hyperkalemia may result from the use of renin-angiotensin-aldosterone system inhibitors (RAASi), which are disease-modifying treatments for these conditions. Therefore, balancing the benefits of optimizing treatment with RAASi while mitigating hyperkalemia is crucial to ensure patients are optimally treated. In this review, we will briefly discuss the definition, causes, epidemiology and consequences of hyperkalemia. The majority of the review will be focused on management of hyperkalemia in the acute and chronic setting, emphasizing contemporary approaches and evolving data on the relevance of dietary restriction and the use of novel potassium binders.
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Affiliation(s)
- Natasha L. Larivée
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada ,Dalhousie University and Horizon Health Network, Saint John, NB Canada
| | - Jacob B. Michaud
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada ,Dalhousie University and Horizon Health Network, Saint John, NB Canada
| | - Keigan M. More
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada
| | - Jo-Anne Wilson
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada
| | - Karthik K. Tennankore
- Dalhousie University and Nova Scotia Health, 5820 University Avenue, Halifax, NS B3H 1V8 Canada
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Zhang Y, Xu R, Wang F, Liu Y, Xu J, Zhao N, Cheng F, Long L, Jia J, Lin S. Effects and Safety of a Novel Oral Potassium-Lowering Drug-Sodium Zirconium Cyclosilicate for the Treatment of Hyperkalemia: a Systematic Review and Meta-Analysis. Cardiovasc Drugs Ther 2021; 35:1057-1066. [PMID: 33459923 PMCID: PMC8452568 DOI: 10.1007/s10557-020-07134-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
Background Oral sodium zirconium cyclosilicate (SZC) is a novel potassium binder capable of achieving a rapid reduction of serum potassium (sK+) and maintaining a long-term normokalemia. We undertook a meta-analysis to summarize and evaluate the effects surrounding SZC in patients with hyperkalemia. Method We searched data sources from MEDLINE (from 1950 to Sep 2020), EMBASE (from 1970 to Sep 2020), and the Cochrane Library database (from 1950 to Sep 2020) for eligible studies. All randomized controlled trials (RCTs) regarding comparison of therapeutic effects of SZC in hyperkalemia participants were included. Results Seven studies, including 1697 patients with hyperkalemia, were analyzed. SZC significantly reduced mean sK+ (−0.42 mmol/L; 95% CI: −0.63 to −0.20 mmol/L, p = 0.0001) compared with placebo, with a significantly greater proportion of patients with normokalemia (RR 3.48, 95% CI 1.49 to 8.11, p = 0.004). Subgroup analyses showed that the longer durations of SZC treatment, the greater magnitudes of potassium reduction when compared with those of placebo (p between subgroups = 0.01) at correction phase. Besides, it also demonstrated sK+ tended to decrease more in patients who got longer treatment or larger dosage of SZC at maintenance phase; however, the difference did not reach statistical significance. Additionally, the drug was equally effective in studies with larger than 50% of patients with chronic kidney disease (CKD) or diabetes or patients using renin-angiotensin aldosterone system inhibitor (RAAS) inhibitors (all p < 0.05). The risk of edema (4.30, 1.17 to 15.84; p = 0.03) in SZC group was higher than those of placebo group. No statistically significant differences in the risks of other adverse events were observed between the two groups. Conclusions SZC effectively decreased the sK+ level in patients with hyperkalemia within 48 h and had benefits in the long-term control of serum potassium in patients who continued to receive SZC with a favorable safety profile from available data. Supplementary Information The online version contains supplementary material available at 10.1007/s10557-020-07134-2.
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Affiliation(s)
- Yaru Zhang
- Department of Nephrology, Hunan Provincial Second People's Hospital, Hunan, China
| | - Ruiling Xu
- Department of Pharmacy, Xiji County People's Hospital, Ningxia, China
| | - Fanghao Wang
- Department of Nephrology, General Hospital of Tianjin Medical University, NO.154, Anshan road, Heping district, Tianjin, China
| | - Youxia Liu
- Department of Nephrology, General Hospital of Tianjin Medical University, NO.154, Anshan road, Heping district, Tianjin, China.
| | - Junying Xu
- Department of Nephrology, Hunan Provincial Second People's Hospital, Hunan, China
| | - Na Zhao
- Department of Nephrology, Qianfoshan Attatched Hospital of Shandong University, Jinan, Shandong province, People's Republic of China
| | - Fajuan Cheng
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong province, People's Republic of China
| | - Lihong Long
- Department of Nephrology, Hunan Provincial Second People's Hospital, Hunan, China
| | - Junya Jia
- Department of Nephrology, General Hospital of Tianjin Medical University, NO.154, Anshan road, Heping district, Tianjin, China
| | - Shan Lin
- Department of Nephrology, General Hospital of Tianjin Medical University, NO.154, Anshan road, Heping district, Tianjin, China
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