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

• Published in: Pediatric nephrology (Berlin, West) West), 2024-04, Vol.39 (4), p.1213-1219
• Main Authors: Khandelwal, Priyanka, Shah, Sarit, McAlister, Louise, Cleghorn, Shelley, King, Lillian, Shroff, Rukshana
• Format: Article
• Language: English
• Subjects: Adult; Age; Blood pressure; Child; Children; Dialysis; Dietary restrictions; Edema; Hemodialysis; Humans; Hyperkalemia; Hyperkalemia - etiology; Hyperkalemia - therapy; Infant; Kidney diseases; Medicine; Medicine & Public Health; Nephrology; Nutritional status; Original Article; Pediatrics; Potassium; Potassium, Dietary; Renal Dialysis - adverse effects; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Silicates; Sodium; Urology; What's New in Dialysis
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-023-06176-6

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). 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