Sodium Zirconium Cyclosilicate for the Acute Management of Hyperkalemia in the Emergency Department

Limited evidence exists examining the use of potassium binders for the acute management of hyperkalemia.

The objective of the study is to evaluate the use of sodium zirconium cyclosilicate (SZC) for the acute management of hyperkalemia.

This retrospective cohort study evaluated patients presenting to the emergency department with an initial potassium ≥5.6 mEq/L and treated with the institutional hyperkalemia order set.

Overall, 189 patients were included. There was no significant difference in serum potassium change from baseline to first potassium within 6 hours between the SZC and non-SZC groups (-1.096 ± 0.71 vs -1.067 mEq/L ± 0.81, P = 0.798), respectively. No significant difference was seen between the SZC and non-SZC groups for time from initial hyperkalemia to order set medication administration (1.9 ± 1 vs 2.5 ± 2.9 hours, P = 0.63), mean hospital length of stay (5.5 ± 4.5 vs 6.6 days ± 6.9, P = 0.197), or potassium level at first recheck (5.17 ± 0.68 vs 5.34 mEq/L ± 0.76, P = 0.108). Time from the first medication administration to potassium recheck differed by about 1 hour between groups (4.1 ± 3.1 vs 5.1 hours ± 3.2, P = 0.035), and patients in the SZC group were less likely to have a potassium >6 mEq/L at the first recheck (10.1% vs 21%, P = 0.047).

The optimal use of SZC in the acute management remains uncertain based on results from this study with no difference in potassium levels at first recheck.