Abstract: SA-PO0511
Potassium Is Not So Scary (Anymore): First Experiences with Sodium Zirconium Cyclosilicate in Croatia
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 3
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Milanovic, Matea, Dubrava University Hospital, Zagreb, Croatia
- Mišković, Zoran M., Zupanijska bolnica Cakovec, Čakovec, Međimurje County, Croatia
- Durlen, Ivan, Dubrava University Hospital, Zagreb, Croatia
- Toric, Luka, Dubrava University Hospital, Zagreb, Croatia
- Babic, Petar, Dubrava University Hospital, Zagreb, Croatia
- Bedalov Crnkovic, Ivana, Dubrava University Hospital, Zagreb, Croatia
- Horvatic, Ivica, Dubrava University Hospital, Zagreb, Croatia
- Crnogorac, Matija, Dubrava University Hospital, Zagreb, Croatia
Background
Sodium zirconium cyclosilicate (SZC) has been available in Croatia only recently and not yet reimbursed by the state insurance. The only available potassium binder in Croatia is calcium polystyrene sulfonate (CPS) which is often not well tolerated and patients sometimes choose not to use it which increases the risk of hyperkaliemia We present first large Croatian cohort of patients treated with SZC.
Methods
The study included 44 CKD patients, 19 (43%) pre-dialytic patients. Pre-dialytic patients used SZC every day, while dialytic patients used it in the inter-dialytic period. Patients were switched to SZC after using CPS, either because it wasn’t effective enough or patients complained of side-effects (mainly gastrointestinal ones). We analysed serum potassium levels prior to and after introducing SZC to patient’s therapy. Differences between potassium levels prior and after the treatment were analysed using ANOVA test.
Results
Out of 44 patients (11 females), median age of 65 (IQR 26-91) there were 19 (43%) pre-dialytic patients, 21 (47%) had type 2 diabetes, 43 (97%) had arterial hypertension and 15 (34%) had cardiovascular comorbidities. All of the patients had RAAS inhibitors, while 29 (65,9%) used Henle loop diuretics. Only 3 (6%) patients needed to have SZC dose permanently raised to 10mg per day, while the rest remained on 5mg per day (dialytic patients in non-dialysis days). Median serum potassium levels at three, two and one month prior to initiation of SZC treatment were 5,6 (IQR 4,9-6,7), 5.6 (IQR 4,7-7,2) and 5,7 (5-7,1) mmol/l respectively and one, two and three months afterwards, 4,7 (IQR 3,5-5,5), 4,7 (IQR 3,3-5) and 4,6 (3,4-5,9) respectively. This presents significant reduction (p <0,0001) of potassium levels. After analysing separately non-dialytic and dialytic patients, the differences remained the same in favour of SZC. Potassium was more challenging to control in diabetic patients and some dialytic patients that were sometimes not regular in taking SZC due to fear of higher daily volume intake.
Conclusion
SZC is the first available alternative to CPS in Croatia. It was well tolerated by all CKD patients ensuring improved and adequate control of potassium levels thus reducing the risk of hyperkalemia.
Funding
- Government Support – Non-U.S.