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Abstract: TH-PO367

Real-World Experience with Sodium Zirconium Cyclosilicate for Hyperkalemia in the Acute Inpatient Setting

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Hirsch, Jamie S., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Fishbane, Steven, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Ng, Jia Hwei, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background

The potassium binder sodium zirconium cyclosilicate (SZC) is often used for hyperkalemia treatment in the hospital. Its utility in this setting remains unknown, having been studied largely among outpatients and patients on dialysis. We sought to evaluate the real-world efficacy of SZC monotherapy for acute hyperkalemia in a large health system with a diverse patient population.

Methods

We included all adult (≥18) patients admitted to emergency departments or hospitals of Northwell Health in 2021-22; who received SZC due to a serum potassium (K) ≥5 mEq/L; and received no concomitant K-lowering therapy (loop diuretics, bicarbonate, insulin, albuterol, potassium binders, dialysis). Only the first SZC dose per patient was analyzed, and K was evaluated for up to 24 hours. We examined the mean reduction in K overall and by predefined hyperkalemia severity stratifications.

Results

Among 4186 patients, mean (SD) age was 71.3 (15.3) years with 55.3% men. Mean (SD) K was 5.6 (0.35) mEq/L. The proportion of patients with K 5-5.4, 5.5-5.9, 6-6.4, and ≥6.5 mEq/L were 39.8%, 50.7%, 7.0%, and 2.4%, respectively. SZC resulted in mean (SD) K decrease 0.56 (0.71) mEq/L within 3 hours, with greater reductions at higher baseline K levels (Figure). By 24 hours, 58.9% of patients had a decline in K of ≥0.5 mEq/L and 77.4% had K <5.5 mEq/L.

Conclusion

In the largest real-world study of SZC monotherapy in the acute setting, we found SZC to be effective for moderately severe acute hyperkalemia. Treatment efficacy was achieved after administration, and most patients had a clinically meaningful response. Further studies could help define the role of SZC with more severe hyperkalemia and when used with other therapeutic agents.

Mean (SE) change in K at intervals by baseline K and overall, and number of patients