Sodium Zirconium Cyclosilicate

Matched real-word evidence studies characterizing the relationship between duration of sodium zirconium cyclosilicate (SZC) therapy and hyperkalemia (HK)-related health care resource utilization (HRU) outcomes have been limited. In this GALVANIZE Outcome matched real-word evidence study, we compared HRU between matched short-term and long-term SZC users overall and in key sub-studies.

A retrospective, matched, observational cohort study.

Adults initiating outpatient SZC identified from a large United States claims database (July 2018-December 2022).

Short-term SZC use (≤30 days) versus long-term SZC use (>90 days).

The composite primary outcome was HK-related hospitalizations or emergency department (ED) visits. Other outcomes included HK-related and all-cause hospitalizations, ED visits, and outpatient visits.

Short-term and long-term SZC users were exactly and propensity score matched. Outcomes were compared during follow-up using generalized estimating equations. Sub-studies were conducted among renin-angiotensin-aldosterone system inhibitor users, patients with renal conditions, Medicare Advantage beneficiaries, and Medicaid beneficiaries.

Among 3,133 eligible matched pairs (mean age 64 years; 58% male; 91% with kidney disease), patients with long-term versus short-term SZC use had a 40% lower rate of HK-related hospitalizations or ED visits (incidence rate ratio [IRR] 0.60 [95% CI, 0.52-0.70]), a 36% lower rate of HK-related hospitalizations (IRR 0.64 [95% CI, 0.55-0.74]), and a 49% lower rate of HK-related ED visits (IRR 0.51 [95% CI, 0.37-0.70]) during follow-up (all P < 0.001). The rates of HK-related outpatient visits were similar between short-term and long-term SZC users (3.22 vs 2.72; IRR 0.85 [95% CI, 0.71-1.01]; P = 0.059). Similar trends were observed for all-cause HRU and across sub-studies.

Claims data contain limited clinical information; residual confounding factors remain possible.

Patients with long-term SZC use had significantly lower rates of HK-related hospitalizations or ED visits than matched patients with short-term SZC use.

Acute hyperkalaemia is a potentially life-threatening electrolyte disturbance frequently encountered in emergency departments. Timely recognition and appropriate treatment are critical to prevent serious complications such as cardiac arrhythmias and death. This narrative review summarises current evidence-based and guideline-based recommendations for the emergency management of hyperkalaemia, with a focus on practical challenges and frequently encountered clinical uncertainties. A selective literature search was conducted using PubMed, EMBASE and major international guidelines, emphasising clinical studies performed in emergency departments or acute care settings.Key treatment principles include therapy with intravenous calcium salts, primarily indicated in patients with ECG changes or serum potassium levels ≥6.5 mmol/L. Insulin-glucose therapy remains a cornerstone of transcellular potassium shifting but carries a considerable risk of subsequent hypoglycaemia, particularly in non-diabetic patients with low baseline glucose levels. Inhaled beta-agonists such as salbutamol provide an effective and synergistic potassium-lowering effect and are recommended in combination with insulin. The use of sodium bicarbonate remains uncertain and its indication appears limited to patients with severe comorbid conditions and metabolic acidosis. Diuretics may support potassium elimination in patients with volume overload, although prospective evidence in ED populations is lacking. Sodium polystyrene sulfonate is no longer recommended due to questionable efficacy and risk of gastrointestinal adverse events. Newer potassium binders, including sodium zirconium cyclosilicate and patiromer, show promise in recent studies but require further validation in acute care settings. Haemodialysis remains the definitive option in refractory cases or patients with end-stage renal disease.