Potassium‐lowering effects of sodium zirconium cyclosilicate in the early post‐transplant period

Abstract

AbstractProblemHyperkalemia is a serious condition among intra‐abdominal transplant recipients, and the safety and efficacy of sodium zirconium cyclosilicate (SZC) for its management during the early post‐transplant period are not well‐established.MethodsAdults who received at least one 10‐g dose of SZC within 14 days after an intra‐abdominal transplant between January 2020 and July 2022 were included in our study. The primary outcome was the change in potassium (K+) levels following the first SZC dose. Other analyses explored adjunctive potassium‐lowering therapies, potential gastrointestinal complications, and patient subgroups based on therapy and transplant type.ResultsAmong the recipients (n = 46), 11 were kidney recipients, 26 were liver recipients, seven were simultaneous liver/kidney recipients, and two were simultaneous pancreas/kidney recipients. The mean time to first dose post‐transplant was 7.6 (±4) days, and the mean change in serum K+ after the initial SZC dose was −.27 mEq (p = .001). No gastrointestinal complications were observed following the SZC dose. The mean increase in serum bicarbonate was .58 mEq (p = .41) following the first dose of SZC. Four kidney recipients required dialysis following the SZC dose.ConclusionThis study represents the largest investigation on the use of SZC in transplant recipients. A single 10‐g dose of SZC reduced serum K+ levels in all subgroups, while the use of adjunctive K+‐lowering therapies did not provide additional reduction beyond the effects of SZC. Importantly, no gastrointestinal complications were observed. These findings suggest that SZC may be a safe and promising therapeutic option for hyperkalemia management following solid organ transplantation.