Mori Daisuke, Namiki Yuta, Sugimachi Ayaka, Kado Manabu, Tamai Shinjiro, Nomi Hiroki, Haga Ryota, Nagatoya Katsuyuki, Yamauchi Atsushi
Clin Nephrol. 2022 May;97(5):255-260. doi: 10.5414/CN110688.
Hyperkalemia is a common electrolyte abnormality in chronic kidney disease (CKD). Sodium zirconium cyclosilicate (SZC) is a novel selective cation exchanger that is used to treat hyperkalemia and may also capture ammonium, which is of a similar size to potassium. We investigated the effect of SZC on acid-base balance in CKD patients. This retrospective study surveyed 20 patients with CKD whose serum potassium levels were maintained within the normal range by treatment with polysulfonate resin, which was replaced with SZC during the clinical course. We compared clinical parameters before and after changing medications. Changing the potassium binder from polysulfonate resin to SZC increased serum bicarbonate (p = 0.016) and decreased blood urea nitrogen (p = 0.017). Serum potassium levels were maintained within the normal range. Urine pH, anion gap, and osmolality gap were unchanged during treatment. No gastrointestinal symptoms were noted during the observation period. Our data suggest that SZC may improve not only hyperkalemia but also metabolic acidosis by increasing the excretion of ammonium from the intestinal tract in patients with CKD. SZC could be a more suitable medication for CKD patients with hyperkalemia and metabolic acidosis.
高钾血症是慢性肾脏病（CKD）中常见的电解质异常。环硅酸锆钠（SZC）是一种新型的选择性阳离子交换剂，用于治疗高钾血症，它还可能捕获与钾大小相似的铵离子。我们研究了SZC对CKD患者酸碱平衡的影响。这项回顾性研究调查了20例CKD患者，这些患者通过聚磺酸盐树脂治疗使血清钾水平维持在正常范围内，在临床过程中用SZC替代了聚磺酸盐树脂。我们比较了更换药物前后的临床参数。将钾结合剂从聚磺酸盐树脂更换为SZC可使血清碳酸氢盐升高（p = 0.016），血尿素氮降低（p = 0.017）。血清钾水平维持在正常范围内。治疗期间尿pH值、阴离子间隙和渗透压间隙未发生变化。观察期内未发现胃肠道症状。我们的数据表明，SZC不仅可以改善高钾血症，还可以通过增加CKD患者肠道铵的排泄来改善代谢性酸中毒。对于患有高钾血症和代谢性酸中毒的CKD患者，SZC可能是一种更合适的药物。
