An evaluation of sodium zirconium cyclosilicate as a treatment option for hyperkalemia

ABSTRACT

Introduction

Hyperkalemia, defined as serum potassium level > 5.0 mEq/l, is associated with serious cardiac dysrhythmias, sudden death and increased mortality risk. It is common in patients with chronic kidney disease (CKD), diabetes (DM) and heart failure (HF), particularly in those treated with the renin-angiotensin-aldosterone system (RAAS) inhibitors or potassium-sparing diuretics. Although these drugs have documented renal and cardiac protective benefits, frequent hyperkalemia associated with their use often dictates administration of suboptimal doses or their discontinuation altogether. Treatment for chronic hyperkalemia in these settings has been challenging; however, the recent introduction of two new potassium-binding resins has revolutionized our approach to treating hyperkalemia.

Areas covered

We review key clinical data relating to the pharmacokinetics, efficacy and safety of sodium zirconium cyclosilicate (SZC) as a treatment option for hyperkalemia

Expert opinion

SZC and Patiromer are promising new agents for lowering serum potassium in hyperkalemic patients, including those with CKD, with and without DM or HF, facilitating the use of the RAAS inhibitors for renal and cardiac protection. Recent randomized clinical trials have shown that SZC effectively lowers serum potassium and maintains normokalemia in most hyperkalemic patients. Clinical trials showed that SZC lowers serum potassium within 1 h, although it is not approved for treating acute hyperkalemia. SZC was well tolerated and associated with minimal adverse effects.

KEYWORDS:

• Hyperkalemia
• potassium
• sodium zirconium cyclosilicate
• SZC
• ZS-9
• patiromer
• sodium polystyrene sulfonate (SPS)

Article highlights

In this review article, we review

• Current therapeutic options for management of hyperkalemia.

• The role of novel potassium binding resins, Patiromer and SZC, with focus on SZC.

• Clinical trial data supporting use of SZC in management of hyperkalemia.

• Pertinent adverse effects and drug-drug interactions, related to SZC.

• Safety and regulatory affairs.

Declaration of interest

W Qunibi has received a research grant from AstraZeneca and has attended an advisory board meeting for them back in May 2019. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One referee declares that their institution has received a research grant from AstraZeneca and Relypsa. They are also a consultant to both companies. Another referee declares to serving as a consultant for Vifor and AstraZeneca, the makers of Potassium Binders. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.