Background and Importance Hyperkalaemia is a common but hazardous complication in patients with chronic kidney disease (CKD). Recent studies showed that new resins are effective in reducing potassium serum levels but its effectiveness is usually tested according to standard recommendations of shock and maintenance doses. Are these recommendations followed in clinical practice? If not, is it equally effective?

Aim and Objectives To evaluate the use and effectiveness of sodium zirconium cyclosilicate (SZC) treatment in routine clinical practice.

Material and Methods Observational and retrospective study carried out in a tertiary level hospital that included patients admitted with hyperkalaemia who started treatment with sodium zirconium cyclosilicate since December 2021.

Drug’s technical data recommends shock dose of 10g/8h for a maximum of 72h until normokalaemia and from there, maintenance regimen with the minimum dose that allows concentrations between 3.5-5mmol/L. Therapeutic Positioning Report recommends reserving its use for patients with failure or intolerance to exchange resins like calcium polystyrene sulfonate (CPS).

Results 32 patients with a median age of 83 years (IQR 14) were recruited, 17 men. Main underlying cause of hyperkalaemia was CKD, 78% of cases.

Only 12.5% of all patients received a shock regimen of 10g/8h, 37.5% received 10g/24h, 6.3% received 5g/8h and 43.8% did not receive shock dose.

Regarding maintenance regimen, most common dosage was 5g/24h in 59.4% of the patients, followed by 10g/24h in 9.4% and 5g/48h in 3.1%. Remaining 28.1% did not receive a maintenance. 44.4% were never treated with resins and 3.7% showed intolerance to them.

Mean potassium concentration before treatment was 5.9 ± 0.7mmol/L. 46.9% of the patients reached target potassium levels(3.5-5mmol/L) at 48h of treatment, 15.6% were below 3.5mmol/L; and 37.5% continued with concentrations above 5 mmol/L, half of whom had received SZC as a single dose.

Conclusion and Relevance A significant percentage of patients did not reach the potassium concentration target after treatment with SZC, which could be related to the lack of shock dose. This agrees with available literature, which concludes that doses higher than 10g/day lead to a greater potassium depletion. Almost one third of patients had not previously received resins so the most efficient option was probably not used since, as cost-comparison studies claim, CPS has a slightly better cost-effectiveness compared to SZC.

Conflict of Interest No conflict of interest