Imamura Teruhiko, Narang Nikhil, Kinugawa Koichiro
Second Department of Medicine, University of Toyama, Toyama 930-0194, Japan.
Advocate Christ Medical Center, Oak Lawn, IL 60453, USA.
J Clin Med. 2022 Nov 30;11(23):7096. doi: 10.3390/jcm11237096.
Background: Sodium zircon`ium cyclosilicate (SZC), a recently introduced potassium binder, is indicated to treat hyperkalemia. SZC is often terminated soon after the normalization of hyperkalemia in real-world clinical practice. We aimed to investigate the risk factors for the rapid recurrence of hyperkalemia following cessation of SZC. Methods: Patients in whom SZC was discontinued following an improvement in hyperkalemia were followed up for three months. The baseline characteristics that were associated with the rapid recurrence of hyperkalemia (>5.0 mEq/L of serum potassium levels within 3 months) were investigated. Results: A total of 44 patients terminated SZC following the normalization of hyperkalemia. The median age was 81 (69, 87) years old, and 59% were men. When evaluating baseline characteristics, a higher dose of renin-angiotensin system inhibitors was significantly associated with the recurrence of hyperkalemia (adjusted hazard ratio of 1.26, 95% confidence interval 1.02−1.69, p = 0.045) at a designated cutoff of 2.5 mg/day of equivalent enalapril dose. Conclusions: SZC should be considered for ongoing continuation after normalization of hyperkalemia, particularly in patients receiving a relatively higher dose of renin-angiotensin system inhibitors.
环硅酸锆钠（SZC）是一种最近引入的钾离子结合剂，用于治疗高钾血症。在实际临床实践中，高钾血症正常化后，SZC治疗常常很快终止。我们旨在调查停用SZC后高钾血症快速复发的危险因素。方法：对高钾血症改善后停用SZC的患者进行为期三个月的随访。研究与高钾血症快速复发（3个月内血清钾水平>5.0 mEq/L）相关的基线特征。结果：共有44例患者在高钾血症正常化后停用SZC。中位年龄为81（69，87）岁，59%为男性。在评估基线特征时，当以依那普利等效剂量2.5 mg/天为指定临界值时，较高剂量的肾素-血管紧张素系统抑制剂与高钾血症复发显著相关（调整后风险比为1.26，95%置信区间1.02−1.69，p = 0.045）。结论：高钾血症正常化后，应考虑持续使用SZC，尤其是在接受相对较高剂量肾素-血管紧张素系统抑制剂的患者中。
