Joi Yam Yau Lin, PharmD
PGY-2 Critical Care Pharmacy Resident
n/a
Brooklyn, NY
Disclosure information not submitted.
Catherine Chun, PharmD, BCPS, BCCP
Clinical Pharmacy Coordinator
NewYork-Presbyterian Brooklyn Methodist Hospital, United States
Disclosure information not submitted.
Spencer Lee, PharmD, BCPS, BCCCP, BCIDP
Clinical Pharmacy Coordinator
NewYork-Presbyterian Brooklyn Methodist Hospital, United States
Disclosure information not submitted.
Joseph Samide, PharmD, BCPS, BCCCP
Clinical Pharmacy Coordinator
NewYork-Presbyterian Brooklyn Methodist Hospital, United States
Disclosure information not submitted.
Eunah Cheon, PharmD, BCPS, BCCCP
Clinical Pharmacy Coordinator
NewYork-Presbyterian Brooklyn Methodist Hospital, United States
Disclosure information not submitted.
Erin Oh, BA, PharmD, BCPS-AQ Cardiology
Clinical Pharmacy Lead & Director of Pharmacy Residency Programs
NewYork-Presbyterian Brooklyn Methodist Hospital, United States
Disclosure information not submitted.
Title: Acute Hyperkalemia: Sodium Zirconium Cyclosilicate Compared to Sodium Polystyrene Sulfonate
Introduction: Sodium polystyrene sulfonate (SPS) has been the mainstay of therapy for the treatment of hyperkalemia, but it has been associated with case reports of gastrointestinal injuries. In May 2018, the Food and Drug Administration approved sodium zirconium cyclosilicate (SZC) for the treatment of hyperkalemia, which demonstrated efficacy in achieving restoration of normokalemia after 24 to 72 hours. In January 2020, SZC replaced SPS as the preferred potassium binder at our institution based on published literature. The objective of this study was to evaluate the resolution of hyperkalemia with SZC containing regimens compared to SPS containing regimens within 24 hours.
Methods: This retrospective chart review was approved by the Institutional Review Board. Patients who were 18 years of age and older and received at least one dose of SZC (from January 2020 to November 2020) or SPS (from January 2019 to September 2019) for the treatment of hyperkalemia were reviewed to be included in the study. Patients who were critically ill, COVID-19 positive, on chronic hemodialysis, on chronic potassium binders, or treated based on a hemolyzed potassium level were excluded from the study. The primary endpoint was the restoration of normokalemia within 24 hours. Secondary endpoints included evaluation of additional doses proximal to a repeat potassium level, magnitude of potassium reduction within 24 hours after potassium binder administration, discontinuation of agents known to cause hyperkalemia, and management of hyperkalemia per or off hospital protocol.
Results: One hundred and twenty-five patients from each arm were included in the primary and secondary endpoint analysis. The primary endpoint occurred in 44% of patients from the SZC arm compared to 40% from the SPS arm (P=0.608). Additional doses prior to and after a repeat potassium level were higher in the SZC arm compared to the SPS arm (32% vs. 4%, P=0.0001; 53.6% vs. 32.8%, P=0.0014). There were no statistically significant differences in the remaining secondary endpoints.
Conclusions: In this retrospective evaluation, SZC and SPS containing regimens were found to be equivalent. Further evaluation is needed to determine which potassium binder is the most operationally efficient and cost effective for acute hyperkalemia.