Effects and Safety of a Novel Oral Potassium-Lowering Drug-Sodium Zirconium Cyclosilicate for the Treatment of Hyperkalemia: a Systematic Review and Meta-Analysis

Zhang, Yaru; Xu, Ruiling; Wang, Fanghao; Liu, Youxia; Xu, Jiankun; Zhao, Na; Cheng, Fajuan; Long, Li‐Hong; Jia, Junya; Lin, Song

doi:10.1007/s10557-020-07134-2

Cited by 18 publications

(15 citation statements)

References 31 publications

(62 reference statements)

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“…Although several systematic reviews have examined the efficacy of these new compounds in lowering serum potassium [ 14 , 15 , 16 , 17 ], no SRs have analyzed whether NPBs allow the optimization of RAASi therapy in HF patients. This is the first quick review in this area.…”

Section: Introductionmentioning

confidence: 99%

Optimization of RAASi Therapy with New Potassium Binders for Patients with Heart Failure and Hyperkalemia: Rapid Review and Meta-Analysis

Montagnani

Frasson

Gussoni

et al. 2021

JCM

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(1) Background: The objective of this rapid review is to assess whether new potassium binders (NPBs) could enable the optimization of RAASi therapy more than usual care or placebo in patients with or at risk of heart failure and hyperkalemia. (2) Methods: We searched for RCTs that included patients with or at risk of hyperkalemia and patients treated with Patiromer or sodium zirconium cyclosilicate (ZSC). The comparators were placebo, usual care, and potassium binders with different doses or different treatment protocols. We searched the Cochrane CENTRAL, MEDLINE, and ClinicalTrials.gov databases. The risk of bias was assessed using the Cochrane risk of bias tool for RCTs. Data were pooled using the random effects model, and the fixed effects model was used for sensitivity analysis. (3) Results: We included 12 studies with 2800 enrolled patients. Only three of these trials (412 patients) were included in the meta-analysis. NPBs seemed to have an effect on the optimization of MRA therapy, with an RR (95% CI) of 1.24 (1.09, 1.42) (moderate certainty evidence); Patiromer seemed to have an effect on MRA optimization, with an RR (95% CI) or 1.25 (1.08, 1.45) (high certainty evidence). ZSC seemed to have no effect on enabling MRA therapy, with an RR (95% CI) of 1.19 (0.89, 1.59) (low certainty evidence). The AEs in HF patients with hyperkalemia treated with Patiromer were GI disorders and hypomagnesemia. ZSC The AEs included chronic cardiac failure, hypokalemia, and edema. (4) Conclusions: This meta-analysis included three studies with a small number of patients and a short follow-up period (1–3 months). The evidence of the effect of NPBs on MRA optimization had a moderate certainty for imprecision. Data on the effect on MRA optimization and less severe AEs in long-term treatment seem to suggest the use of Patiromer for the optimization of MRA therapy in patients with or at risk of heart failure and hyperkalemia. Future adequately powered RCTs are needed to assess the benefits and potential harms of potassium binders.

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Section: Introductionmentioning

confidence: 99%

Optimization of RAASi Therapy with New Potassium Binders for Patients with Heart Failure and Hyperkalemia: Rapid Review and Meta-Analysis

Montagnani

Frasson

Gussoni

et al. 2021

JCM

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“…NICE assumed these products were beneficial based on data looking at patients requiring long term hyperkalaemia treatment in renal impairment rather than in the treatment of acute hyperkalaemia. Their effectiveness in acute hyperkalaemia is based on small scale early phase 22 study or uncontrolled evidence 23,24 . Such studies have allowed drug companies to have marketed these newer agents putting forward potential reasons why these drugs may be expected to be highly effective compared to the traditional agents, such as fast onset of action 25 .…”

Section: Resultsmentioning

confidence: 99%

“…Their effectiveness in acute hyperkalaemia is based on small scale early phase 22 study or uncontrolled evidence. 23,24 Such studies have allowed drug companies to have marketed these newer agents putting forward potential reasons why these drugs may be expected to be highly effective compared to the traditional agents, such as fast onset of action. 25 Although such statements are enticing and undoubtedly a good marketing ploy, our small-scale observational study indicates that CPS and SZC have similar onset of actions with both agents producing similar reductions in potassium concentrations over a 24-and 48-h timeframe.…”

Section: Discussionmentioning

confidence: 99%

Hyperkalaemia and potassium binders: Retrospective observational analysis looking at the efficacy and cost effectiveness of calcium polystyrene sulfonate and sodium zirconium cyclosilicate

Huda

Langford

Lake

et al. 2022

Clinical Pharmacy Therapeu

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What is Known and Objective: Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS).Methods: A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics.Based on the results a naïve cost comparison between the two drugs was made.Results and Discussion: CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input.What is New and Conclusion: Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies.

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“…The advantage of such agents may be that they enable maximal RAAS blockade without discontinuation or due to hyperkalaemia. 95 …”

Section: Possible Future Therapiesmentioning

confidence: 99%

Pharmacotherapy to delay the progression of diabetic kidney disease in people with type 2 diabetes: past, present and future

Mallik

Chowdhury

2022

Therapeutic Advances in Endocrinology

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Diabetic kidney disease (DKD) is a leading cause of morbidity and mortality among people living with diabetes, and is one of the most important causes of end stage renal disease worldwide. In order to reduce progression of DKD, important management goals include treatment of hypertension, glycaemia and control of cardiovascular risk factors such as lipids, diet, smoking and exercise. Use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers has an established role in prevention of progression of DKD. A number of other agents such as endothelin-1 receptor antagonists and bardoxolone have had disappointing results. Recent studies have, however, suggested that newer antidiabetic agents such as sodium-glucose transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 analogues have specific beneficial effects in patients with DKD. Indeed most recent guidance suggest that SGLT-2i drugs should be used early in DKD, irrespective of glucose control. A number of pathways are hypothesised for the development and progression of DKD, and have opened up a number of newer potential therapeutic targets. This article aims to discuss management of DKD with respect to seminal trials from the past, more recent trials informing the present and potential new therapeutic options that may be available in the future.

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Effects and Safety of a Novel Oral Potassium-Lowering Drug-Sodium Zirconium Cyclosilicate for the Treatment of Hyperkalemia: a Systematic Review and Meta-Analysis

Cited by 18 publications

References 31 publications

Optimization of RAASi Therapy with New Potassium Binders for Patients with Heart Failure and Hyperkalemia: Rapid Review and Meta-Analysis

Optimization of RAASi Therapy with New Potassium Binders for Patients with Heart Failure and Hyperkalemia: Rapid Review and Meta-Analysis

Hyperkalaemia and potassium binders: Retrospective observational analysis looking at the efficacy and cost effectiveness of calcium polystyrene sulfonate and sodium zirconium cyclosilicate

Pharmacotherapy to delay the progression of diabetic kidney disease in people with type 2 diabetes: past, present and future

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