Sodium Zirconium Cyclosilicate for the Treatment of Hyperkalemia in End-Stage Renal Disease Patients: A Meta Analysis

Hyperkalemia, characterized by elevated serum potassium levels, is a common and serious condition in patients with Chronic Kidney Disease (CKD). Sodium zirconium cyclosilicate (SZC) is an oral medication that enhances potassium excretion in the feces by selectively capturing potassium ions in exchange for sodium and hydrogen ions. This meta-analysis aims to evaluate the efficacy of SZC in managing hyperkalemia in CKD patients. A comprehensive literature search was conducted up to December 28, 2024, across databases including PubMed, ScienceDirect, and the Cochrane Library, using specific keywords related to sodium zirconium cyclosilicate and hyperkalemia in CKD. Inclusion criteria focused on studies assessing the effect of SZC on serum potassium levels in CKD patients with hyperkalemia. A total of 4 studies were included for quantitative synthesis, and the risk of bias was assessed using the RoB-2 tool. The meta-analysis revealed a significant mean difference in serum potassium levels between the SZC and placebo groups, with a reduction of -0.53 (95% CI -0.65 to -0.41; p < 0.00001). The analysis indicated moderate heterogeneity (I² = 51%). SZC demonstrated rapid efficacy in lowering serum potassium levels, achieving significant reductions within 48 hours of treatment. Sodium zirconium cyclosilicate is effective in rapidly reducing serum potassium levels in patients with hyperkalemia associated with Chronic Kidney Disease. Its ability to maintain normokalemia for up to four weeks highlights its potential as a preferred treatment option for acute hyperkalemia. Further research with larger sample sizes is warranted to confirm these findings and explore long-term outcomes.