Intermittent Sodium Zirconium Cyclosilicate for the Prevention of Hyperkalemia in CKD

Background: Sodium zirconium cyclosilicate emerged as an effective short-term treatment for acute hyperkalemia. Recent evidence supports its use for long-term control of hyperkalemia, but the recommended daily dosage is expensive and may not be well tolerated. We determined the efficacy and safety of intermittent sodium zirconium cyclosilicate therapy for the prevention of hyperkalemia in CKD patients. Methods: We reviewed 36 patients who received intermittent (1 to 2 doses weekly) sodium zirconium cyclosilicate for more than 3 months. We analyzed plasma potassium levels, episodes of hyperkalemia, emergency room attendance, and hospitalizations before and during sodium zirconium cyclosilicate treatment. Results: The total duration of observation was 274 patient-months with Lokelma treatment and 216 patient months in the control period; the median duration of Lokelma treatment was 4.4 months (IQR 3.0 – 10.4 months). The median plasma potassium level decreased from 5.10 (IQR 4.91 – 5.40) to 4.73 (IQR 4.50 – 5.10) mmol/l (p = 0.0003). There were 114 episodes of hyperkalemia during the control period and 57 episodes during Lokelma treatment. The median incidene of 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). Similarly, the incidence of moderate hyperkalemia reduced from 2.0 (IQR 0.0 – 4.0) to 0.0 (IQR 0.0 – 0.2) episode per patient-year (p = 0.001). There was no significant difference in the total hospitalization or attendance to the Emergency Department. Conclusion: Intermittent low dose sodium zirconium cyclosilicate is effective for potassium control and enhances the management of hyperkalemia in CKD.