Potassium Homeostasis in Health and Disease: A Scientific Workshop Cosponsored by the National Kidney Foundation and the American Society of Hypertension

Sodium Zirconium Cyclosilicate: A Review in Hyperkalaemia

“…muscle and nerve) cells [2, 3, 6]. The most concerning effects are on cardiac cells, with cell membrane depolarization reducing cardiac excitability and the action potential duration, and slowing conduction, leading to bradyarrhythmias, ventricular fibrillation and asystole [2, 3, 6, 7]. …”

“…The UK clinical practice guidelines on the treatment of acute hyperkalaemia in adults [4] and a recent scientific workshop (cosponsored by the National Kidney Foundation and the American Society of Hypertension) report on potassium homeostasis in health and disease [7] both recommend the use of calcium (to stabilize cardiac conduction) and glucose, insulin and a β 2 -adrenergic receptor agonist (e.g. salbutamol) [to redistribute extracellular potassium to the intracellular space] for the acute management of hyperkalaemia, with the scientific workshop report also recommending sodium bicarbonate as an option for patients with concurrent metabolic acidosis [7].…”

“…salbutamol) [to redistribute extracellular potassium to the intracellular space] for the acute management of hyperkalaemia, with the scientific workshop report also recommending sodium bicarbonate as an option for patients with concurrent metabolic acidosis [7]. To encourage potassium excretion, the use of cation-exchange resins is recommended in the UK clinical practice guidelines [4] for the management of acute mild to moderate hyperkalaemia, and the use of potassium-binding agents or potassium-wasting diuretics is recommended in the scientific workshop report for the long-term management of hyperkalaemia [7]. However, such methods are reported to be used less frequently than a dose reduction in or the discontinuation of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and potassium-sparing diuretics [7].…”

“…Moreover, SPS should be used cautiously in patients who are unable to tolerate even small increases in sodium levels (such as those with hypertension, oedema or severe congestive heart failure) [2]. Recently, two potassium-binding agents (SZC and patiromer) have been developed [7]. Both are insoluble, non-absorbed powders for oral suspension; however, SZC is a non-polymer and exchanges hydrogen and sodium for potassium and ammonium ions in the GIT (Sect.…”

“…Potassium-binding agents act by increasing faecal potassium excretion [2, 7]. One such recently developed agent is the non-absorbed, cation exchanger sodium zirconium cyclosilicate (Lokelma™) [hereafter referred to as SZC], which is available as a powder for oral suspension (in water) [8, 9].…”