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Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis

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Abstract

Background

Sodium zirconium cyclosilicate (SZC), an ion-exchange resin, is effective in the control of hyperkalemia in adults with chronic kidney disease (CKD); reports of use in children are limited. Prolonged therapy with SZC to relax dietary potassium restriction in CKD has not been examined.

Methods

We conducted a retrospective chart review of patients 6 months to 18 years of age with CKD stage 4–5 or on dialysis (5D) administered SZC for sustained hyperkalemia (potassium ≥ 5.5 mEq/L, three consecutive values). Patients received SZC (0.5–10 g per dose; age-based) either short-term (< 30 days) or long-term (> 30 days).

Results

Twenty patients with median age 10.8 (inter-quartile range 3.9, 13.4) years were treated with SZC. Short-term SZC, for 5 (3, 19) days, was associated with safe management of dialysis catheter insertions (n = 5) and access dysfunction (n = 4), and was useful during palliative care (n = 1). Serum potassium levels decreased from 6.7 (6.1, 6.9) to 4.4 (3.7, 5.2) mEq/L (P < 0.001). Long-term SZC for 5.3 (4.2, 10.1) months achieved decline in serum potassium from 6.1 (5.8, 6.4) to 4.8 (4.2, 5.4) mEq/L (P < 0.001). SZC use was associated with liberalization of diet (n = 6) and was useful in patients with poor adherence to dietary restriction (n = 3). Adverse events or edema were not observed; serum sodium and blood pressure remained stable.

Conclusions

SZC was safe and effective for the management of acute and chronic hyperkalemia in children with CKD4-5/5D. Its use was associated with relaxation of dietary potassium restriction. Studies to examine its routine use to improve diet and nutritional status in children with CKD are required.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, WC1N 3JH, UK

    Priyanka Khandelwal & Rukshana Shroff

  2. Pharmacy Department, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK

    Sarit Shah

  3. Dietetic Department, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK

    Louise McAlister, Shelley Cleghorn & Lillian King

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  1. Priyanka Khandelwal
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Correspondence to Rukshana Shroff.

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Khandelwal, P., Shah, S., McAlister, L. et al. Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis. Pediatr Nephrol 39, 1213–1219 (2024). https://doi.org/10.1007/s00467-023-06176-6

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  • DOI: https://doi.org/10.1007/s00467-023-06176-6

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