Background: Patients with end-stage kidney disease (ESKD) on maintenance dialysis have a high risk of developing hyperkalemia. In addition to traditional approaches, a new option for the management of patients on dial...Background: Patients with end-stage kidney disease (ESKD) on maintenance dialysis have a high risk of developing hyperkalemia. In addition to traditional approaches, a new option for the management of patients on dialysis includes the use of a potassium binder, sodium zirconium cyclosilicate (SZC). We evaluated the effect and safety of SZC in patients with chronic PD. Objective: To present a case series that illustrates the real-world use of new potassium-binders in hyperkalemic patients on peritoneal dialysis. Methods: This case series collected 9 patients on PD with baseline potassium values > 5.5 mmol/l and who were treated with SZC 5 g once a day. Data were collected at baseline and at 1, 2, and 3 months after initiation of treatment. Results: The median age of patients was 64.5 years and the median duration of observation was 90 ± 5 days. It was observed that median serum potassium decreased (5.8 mmol/l at baseline with a range of 5.8 mmol/L - 6.8 mmol/L versus 4.5 in the third month with a range of 3.6 mmol/L - 5.3 mmol/L) after SZC treatment. Adverse events were observed in 2 (22.2%). The unique adverse event was constipation and presented in 2 patients (22.2%). Constipation was mild and transient during the observation period. No adverse events of special interest were reported. Conclusion: Normokalemia was established and maintained in this series of patients treated with SZC. No episodes of hyper- or hypo-kalemia were observed. SCZ had a good safety profile and was well tolerated over 3 months.展开更多
Acute and chronic hyperkalemia is linked to higher hospitalization rates and mortality rates. It has a high prevalence among dialysis and non-dialysis patients in Egypt. The current therapy options are not that ideal....Acute and chronic hyperkalemia is linked to higher hospitalization rates and mortality rates. It has a high prevalence among dialysis and non-dialysis patients in Egypt. The current therapy options are not that ideal. Moreover, we have a critical management paradox in cardiorenal diseases: Should we use the optimum dose of RAASi with its higher incidence of HK, or should we decrease the dose or even stop it with all its harmful hazards? Therefore, in light of the recent updates in different clinical practice guidelines, we, a country-specific (Egypt) task force, gathered to develop a clear, evidence-based, and multi-disciplinary consensus for managing HK. This manuscript illustrates the recommendations of this expert committee. The panel recommends new evidenced K binders like Sodium Zirconium Cyclosilicate (SZC) and patiromer to help manage HK in cardiorenal patients as stated by different international guidelines. In emergency settings, SZC can have a role in managing acute HK;however, it should be used in addition to other drugs like insulin and glucose. Local research studies on the utilization of these novel K binders are highly recommended. The utilization of these novel K binders as prophylaxis should be tested first in a well-designed randomized controlled trial.展开更多
文摘Background: Patients with end-stage kidney disease (ESKD) on maintenance dialysis have a high risk of developing hyperkalemia. In addition to traditional approaches, a new option for the management of patients on dialysis includes the use of a potassium binder, sodium zirconium cyclosilicate (SZC). We evaluated the effect and safety of SZC in patients with chronic PD. Objective: To present a case series that illustrates the real-world use of new potassium-binders in hyperkalemic patients on peritoneal dialysis. Methods: This case series collected 9 patients on PD with baseline potassium values > 5.5 mmol/l and who were treated with SZC 5 g once a day. Data were collected at baseline and at 1, 2, and 3 months after initiation of treatment. Results: The median age of patients was 64.5 years and the median duration of observation was 90 ± 5 days. It was observed that median serum potassium decreased (5.8 mmol/l at baseline with a range of 5.8 mmol/L - 6.8 mmol/L versus 4.5 in the third month with a range of 3.6 mmol/L - 5.3 mmol/L) after SZC treatment. Adverse events were observed in 2 (22.2%). The unique adverse event was constipation and presented in 2 patients (22.2%). Constipation was mild and transient during the observation period. No adverse events of special interest were reported. Conclusion: Normokalemia was established and maintained in this series of patients treated with SZC. No episodes of hyper- or hypo-kalemia were observed. SCZ had a good safety profile and was well tolerated over 3 months.
文摘Acute and chronic hyperkalemia is linked to higher hospitalization rates and mortality rates. It has a high prevalence among dialysis and non-dialysis patients in Egypt. The current therapy options are not that ideal. Moreover, we have a critical management paradox in cardiorenal diseases: Should we use the optimum dose of RAASi with its higher incidence of HK, or should we decrease the dose or even stop it with all its harmful hazards? Therefore, in light of the recent updates in different clinical practice guidelines, we, a country-specific (Egypt) task force, gathered to develop a clear, evidence-based, and multi-disciplinary consensus for managing HK. This manuscript illustrates the recommendations of this expert committee. The panel recommends new evidenced K binders like Sodium Zirconium Cyclosilicate (SZC) and patiromer to help manage HK in cardiorenal patients as stated by different international guidelines. In emergency settings, SZC can have a role in managing acute HK;however, it should be used in addition to other drugs like insulin and glucose. Local research studies on the utilization of these novel K binders are highly recommended. The utilization of these novel K binders as prophylaxis should be tested first in a well-designed randomized controlled trial.
