Nakayama Takashin, Yamaguchi Shintaro, Hayashi Kaori, Uchiyama Kiyotaka, Tajima Takaya, Azegami Tatsuhiko, Morimoto Kohkichi, Yoshida Tadashi, Yoshino Jun, Monkawa Toshiaki, Kanda Takeshi, Itoh Hiroshi
Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Keio University Health Center, Yokohama, Japan.
Front Med (Lausanne). 2023 Mar 6;10:1137981. doi: 10.3389/fmed.2023.1137981. eCollection 2023.
Hyperkalemia is a well-recognized electrolyte abnormality in patients with chronic kidney disease (CKD). Potassium binders are often used to prevent and treat hyperkalemia. However, few studies have evaluated the difference in serum potassium (K) level-lowering effect during the post-acute phase between the novel potassium binder, sodium zirconium cyclosilicate (ZSC), and conventional agents. This retrospective study included patients who received potassium binders (either ZSC or calcium polystyrene sulfonate [CPS]) in our hospital between May 2020 and July 2022. The patients were divided into the ZSC and CPS groups. After propensity score matching, we compared changes from baseline to the first follow-up point, at least 4 weeks after initiating potassium binders, in electrolytes including K level between the two groups. Of the 132 patients, ZSC and CPS were administered in 48 and 84 patients, respectively. After matching, 38 patients were allocated to each group. The ZSC group showed greater reduction in K levels than did the CPS group ( < 0.05). Moreover, a significant increase in serum sodium minus chloride levels, a surrogate marker for metabolic acidosis, was observed in the ZSC group ( < 0.05). Our results demonstrated that ZSC could potentially improve hyperkalemia and metabolic acidosis in patients with CKD.
高钾血症是慢性肾脏病（CKD）患者中一种广为人知的电解质异常。钾结合剂常用于预防和治疗高钾血症。然而，很少有研究评估新型钾结合剂环硅酸锆钠（ZSC）与传统药物在急性期后降低血清钾（K）水平效果上的差异。这项回顾性研究纳入了2020年5月至2022年7月期间在我院接受钾结合剂（ZSC或聚苯乙烯磺酸钙[CPS]）治疗的患者。将患者分为ZSC组和CPS组。在倾向得分匹配后，我们比较了两组在开始使用钾结合剂至少4周后的首次随访点，从基线到该点时包括钾水平在内的电解质变化。132例患者中，分别有48例和84例接受了ZSC和CPS治疗。匹配后，每组分配38例患者。ZSC组的钾水平降低幅度大于CPS组（<0.05）。此外，在ZSC组中观察到血清钠减去氯水平显著升高，这是代谢性酸中毒的替代标志物（<0.05）。我们的结果表明，ZSC可能改善CKD患者的高钾血症和代谢性酸中毒。
