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4CPS-138 Use of sodium zirconium cyclosilicate in hyperkalaemic emergencies
  1. R Fuster Talens,
  2. A Bas Castillo,
  3. MI Gil Gómez,
  4. R Olives Casasnovas,
  5. MDM Betoret Vilar,
  6. P Blasco Segura
  1. Consorcio Hospital General Universitario, Servicio de Farmacia, Valencia, Spain


Background and Importance Hyperkalaemia (K>5.5 mEq/L) is an electrolyte alteration that can determine fatal clinical complications, the most serious being cardiovascular and muscular. Sodium zirconium cyclosilicate binds potassium throughout the gastrointestinal tract reducing serum potassium levels and increasing faecal excretion to resolve hyperkalaemia.

Aim and Objectives Analysis of the effectiveness of sodium zirconium cyclosilicate (SZC, Lokelma®) for the treatment of hyperkalaemia in patients treated in hospital emergency or in different hospitalisation units in the first 48 hours.

Material and Methods One-year retrospective and observational study was carried, including patients treated in hospital emergency or admitted with initial potassium levels ≥5.5 mEq/L who received SZC. The SZC regimen was 10 g every 8 h orally. Serum potassium concentrations were considered normal with values between 3.3-5.1 mEq/L. The variables collected were age, sex, diagnosis of heart failure, serum potassium concentrations (at 0, 24, and 48 hours after starting treatment with SZC), the reason for hyperkalaemia, glomerular filtration rate (GFR, estimated with CKD-EPI formula), concomitant drugs that could influence the hyperkalaemia.

Results 66 patients (63% men) with a median age of 79 years (41-97) were included. Heart failure was diagnosed in 27 patients (41.0%). The GFR was <60 ml/min/1.73 m2 in 61 patients (92.0%) and <30 ml/min/1.73 m2 in 41 (62.0%). The causes of hyperkalaemia were: chronic kidney disease (CKD) (47.0%, N=31), acute kidney disease (AKD) (39.4%, N=26), iatrogenic (7.6%, N=5) and other causes (6.0%, N=4). The drugs contributing to hyperkalaemia were angiotensin-receptor blockers (41.0%, N=27), aldosterone antagonists (28.8%, N=19), non-steroidal anti-inflammatory drug (24.2%, N=16), and angiotensin-converting enzyme inhibitors (16.7%, N=11).

Initial serum potassium concentration mean was 6.4 mEq/L (5.5-8.2), being >7.5 mEq/L in 21 patients (32.0%). Mean reduction in potassium concentrations at 24 hours was 14.1% (N=22) and 22.5% (N=21) at 48 hours. 24 hours after starting treatment with SZC, potassium concentrations were normalised in 33.3% (N=22) of patients and in 31.8% (N=21) after 48 hours.

Conclusion and Relevance Hyperkalaemic emergencies are fundamentally associated with patients with AKD, CKD and in concomitant treatment with drugs inducing hyperkalaemia. SZC treatment is an alternative to be considered in patients with hyperkalaemic emergencies, contributing to the normalisation of serum potassium levels in first 24-48 hours after starting treatment.

Conflict of Interest No conflict of interest

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