Authors' objectives: Sodium zirconium cyclosilicate is a potassium binder that is intended for the treatment of hyperkalaemia. Hyperkalaemia, the term used to describe excess serum potassium, predominantly affects those with acute or chronic kidney failure. This condition causes rapid reduction in resting membrane potential, which can lead to increased cardiac depolarisation and muscle excitability, which in turn leads to electrocardiographic (EGG) changes. At levels above 6.5mmol/L, the risk of ventricular fibrillation or asystole increases quickly. The majority of cases of hyperkalaemia are observed in those patients prescribed angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), often in conjunction with spironolactone in those with pre-existing or new renal impairment. Hyperkalaemia occurs in up to 10% of hospitalised patients, of which 77% of cases are thought to be due to renal failure and 63% to prescribed drugs. In 2012-13, there were 6,344 admissions for hyperkalaemia in England, resulting in 20,457 bed-days and 8,662 finished consultant episodes. The treatment of hyperkalaemia involves the removal of any precipitating drugs and reduction of excess potassium from fluids or food. Calcium gluconate is given to reduce cardiac cell membrane excitability. To help shift potassium from the extracellular domain to the intracellular space, patients may be given a rapid acting insulin (with glucose to avoid hypoglycaemia) or nebulised salbutamol, although the response is not always consistent. Some patients may be given ion-exchange resins, such as polystyrene sulfonate resins (for example calcium resonium) to remove serum potassium from the body. Those patients that do not respond to these treatments, or are on long term dialysis or with advanced chronic kidney disease will require dialysis. Sodium zirconium cyclosilicate is currently in one phase III clinical trial testing the safety and efficacy of its long term use. This trial is expected to complete in August 2016.

Project Status: Completed

Year Published: 2015

URL for published report: www.hsric.nihr.ac.uk/topics/sodium-zirconium-cyclosilicate-for-hyperkalaemia-first-line/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Horizon Scanning Centre

Contact Address: The NIHR Horizon Scanning Centre, Department of Public Health, Epidemiology, and Biostatistics, School of Health and Population Sciences, University of Birmingham, 90 Vincent Drive, Edgbaston, Birmingham, B15 2SP. United Kingdom. Tel: +44 121 414 7831, Fax: +44 121 2269

Contact Name: c.packer@bham.ac.uk

Contact Email: c.packer@bham.ac.uk

Copyright: NIHR Horizon Scanning Centre (NIHR HSC)