Sodium zirconium cyclosilicate in hyperkalaemia: a profile of its use

Abstract

Sodium zirconium cyclosilicate (SZC) [Lokelma™] is a useful oral option for the treatment of hyperkalaemia in adults. As a non-absorbed, non-polymer compound, SZC lowers serum potassium levels by binding potassium in the gastrointestinal (GI) tract and promoting faecal potassium excretion. SZC is effective in restoring and maintaining normokalaemia and is generally well tolerated; most adverse events reported in phase 3 clinical trials were manageable without treatment interruption. SZC appears to be effective and generally well tolerated regardless of common factors associated with hyperkalaemia, including concomitant renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, chronic kidney disease, diabetes and heart failure. Recent data suggest that SZC is also effective and similarly well tolerated in patients with end-stage kidney disease receiving haemodialysis, who typically have persistent predialysis hyperkalaemia. Real-world data and additional long-term data will be valuable in more definitively establishing the position of SZC in the treatment of hyperkalaemia.