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Rastogi A, Hanna RM, Mkrttchyan A, Khalid M, Yaqoob S, Shaffer K, Dhawan P, Nobakht N, Kamgar M, Goshtaseb R, Sarmosyan K, Gnarini M, Wassef O, Lerma E. Sodium zirconium cyclosilicate for the management of chronic hyperkalemia in kidney disease, a novel agent. Expert Rev Clin Pharmacol 2021; 14:1055-1064. [PMID: 34227913 DOI: 10.1080/17512433.2021.1932460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hyperkalemia is a common finding in patients with advanced kidney disease for multiple reasons. Renin-Angiotensin-Aldosterone-System Inhibitors (RAASi) that are indicated for slowing down progression of kidney disease are often associated with hyperkalemia which becomes a limiting factor in their use and titration to the maximum dose. Having a safe, effective, tolerable, and affordable potassium binder can help optimize RAAS inhibition in the setting of kidney disease. AREAS COVERED Although sodium polystyrene sulfonate has been a mainstay of acute management of hyperkalemia for decades, evidence regarding its efficacy is limited, and its chronic use is not routinely recommended for concerns regarding toxicity. The concern of gastrointestinal (GI) adverse effects with sodium polystyrene sulfonate has spurred the development of alternatives. Sodium zirconium cyclosilicate (SZC) is a promising agent that selectively binds potassium in the gut and eliminates it, while being safe for chronic use based on 1 year of data. Even though we do not have head-to-head studies among the three currently available binders, SZC stands out in rapidity of onset and efficacy. EXPERT OPINION In this review, we summarize the general management of hyperkalemia, including new agents. We review the pre-clinical and clinical data relating to sodium zirconium cyclosilicate.
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Affiliation(s)
- Anjay Rastogi
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Ramy M Hanna
- Department of Medicine, Division of Nephrology, University of California Irvine Medical Center, USA
| | - Anita Mkrttchyan
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Maham Khalid
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Sinan Yaqoob
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Kelly Shaffer
- Department of Medicine, UCLA CORE Kidney Health Program Collaborator, USA
| | - Puneet Dhawan
- Division of Cardiothoracic Surgery at David Geffen School of Medicine, UCLA, USA
| | - Niloofar Nobakht
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Mohammad Kamgar
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Ray Goshtaseb
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | - Kristine Sarmosyan
- CORE Kidney Health Program at David Geffen School of Medicine, UCLA, USA.,Department of Medicine, Division of Nephrology, UCLA-Health, USA
| | | | - Olivia Wassef
- Department of Medicine, UCLA CORE Kidney Health Program Collaborator, USA
| | - Edgar Lerma
- Division of Nephrology, University of Illinois at Chicago, Chicago, USA
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