Abstract: FR-PO0894
Hyperkalemia Treatment with Sodium Zirconium Cyclosilicate in a Patient with a High-Output Ileostomy
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 1
October 23, 2026 | Location: Exhibit Hall A, 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
- Roy, Gargi, Renal Unit, St James's Hospital, Dublin, Ireland
- Bowden, Adam, Renal Unit, St James's Hospital, Dublin, Ireland
- Griffin, Brenda, Renal Unit, St James's Hospital, Dublin, Ireland
- Jayawardene, Satish, Renal Unit, St James's Hospital, Dublin, Ireland
- Sexton, Donal J., Renal Unit, St James's Hospital, Dublin, Ireland
Introduction
Sodium zirconium cyclosilicate (ZS-9) is a selective cation exchanger with high efficacy in hyperkalemia management. In contrast to most potassium (K+) binders which predominantly act in the colon, the insoluble crystalline structure of ZS-9 enables K+ entrapment throughout the entire gastrointestinal (GI) tract, commencing in the stomach. There are limited studies on its use in patients with prior bowel surgery however, potentially owing to the adverse GI effects historically associated with K+ binding resins. Herein we report the first case, to our knowledge, of ZS-9 successfully used to treat refractory hyperkalemia in a patient with an end-ileostomy and type 4 renal tubular acidosis (RTA) without any observed adverse events.
Case Description
A 71-year-old female with poorly controlled insulin-dependent diabetes required several hospital admissions for recalcitrant hyperkalemia. She had an end-ileostomy fashioned for ischaemic colitis that was often complicated by high stoma output. A diagnosis of type 4 RTA was made in the context of diabetic nephropathy, with co-existent metabolic acidosis secondary to chronic ileostomy bicarbonate loss. She had recurrent hyperkalemia (K+ range 6-7 mmol/L) despite conservative measures including administration of insulin-dextrose, intravenous diuretics, isotonic sodium bicarbonate, fludrocortisone, indapamide, and improved glycaemic control. Renal replacement therapy (RRT) was required in 2020 following a hyperkalemia-induced cardiac arrest. The patient was subsequently deemed unsuitable for chronic RRT. ZS-9 was trialled in 2023 following its licensing for use in Ireland (dose of 10g three times daily for hyperkalemia and 5g once daily for normokalemia). The patient subsequently remained in hospital for eighteen months due to multimorbidity. She remained on ZS-9 throughout her protracted admission and K+ levels normalised without requiring additional hyperkalemia treatment. No ZS-9 attributable adverse effects were observed.
Discussion
Our case illustrates the potential for ZS-9 to effectively treat hyperkalemia in patients with a resected or non-functioning large intestine, in contrast to established oral K+ binders. It further supports the suggested ability of ZS-9 to begin K+ binding in the upper GI tract, namely the stomach. Larger studies of the use of ZS-9 in patients with hyperkalamia and ilesotomies are required to confirm our findings.