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Abstract: TH-PO1153

Heart Failure and Edema Events Associated with Sodium Zirconium Cyclosilicate vs. Patiromer Treatment

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Desai, Nihar, Yale School of Medicine, New Haven, Connecticut, United States
  • Olopoenia, Abisola, Cerner Enviza LLC, North Kansas City, Missouri, United States
  • Kammerer, Jennifer A., Vifor Pharma Management Ltd, Glattbrugg, Zurich, Switzerland
  • Budden, Jeffrey J., Vifor Pharma Management Ltd, Glattbrugg, Zurich, Switzerland
  • Gordon, Alexandra C, Cerner Enviza LLC, North Kansas City, Missouri, United States
  • Tysseling, Asa C, Cerner Enviza LLC, North Kansas City, Missouri, United States

Sodium zirconium cyclosilicate (SZC) and patiromer (PAT) are potassium binders that differ by exchange ion, sodium, and calcium, respectively. There is limited data on whether using sodium exchange could impact the risks of hospitalizations for heart failure (HHF) or severe edema in patients with hyperkalemia. We assessed the occurrence rates of pre-specified major encounters potentially related to electrolyte-/fluid-related imbalances when stratified by new users of PAT or SZC.


Using Cerner Real World Data, we conducted a retrospective cohort study among patients who were newly initiated on SZC or PAT between June 1, 2018, and December 31, 2021. Adults (≥ 18 years) were followed from their first SZC or PAT prescription (index date) until the end of the 6-month follow up period. We analyzed the occurrence of pre-specified outcomes, discontinuation of or switch from index medication or death. Based on baseline demographic and clinical characteristics, 1 PAT initiator was propensity score matched with 2 SZC initiators. Primary outcomes were any HHF, primary HHF, major edema encounter (MEE), or death. Cox Proportional Hazard regression models were used to estimate the association between SZC or PAT use and each outcome in the overall population and subgroups with/without prior heart failure (HF).


The final cohort included 9,929 PAT initiators matched to 19, 849 SZC initiators. Mean age was 66 years old; about 50% had a history of chronic kidney disease stages 3-5, and 34% a history of HF. Incidence rates (IR) and risks of all outcomes: HHF (any/primary), MEE, and death were significantly higher in the SZC cohort compared to the PAT cohort. These findings were consistent among subgroups with/without prior HF (Fig. 1).


In this real-world data, SZC use (vs. PAT) is associated with increased risk of pre-specified encounters potentially sodium-/fluid-related, including among patients with/without pre-existing HF.

Fig. 1: Incidence rates (per person-months), risk difference, crude and adjusted hazard ratios for SZC use (vs. PAT)


  • Commercial Support – Vifor