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Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure

Background: Sodium zirconium cyclosilicate (SZC), a newly introduced potassium binder, is indicated for treating hyperkalemia. SZC-incorporated up-titration of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists has been recommended for those with systolic heart failure, w...

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Autores principales: Imamura, Teruhiko, Narang, Nikhil, Kinugawa, Koichiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9504621/
https://www.ncbi.nlm.nih.gov/pubmed/36142977
http://dx.doi.org/10.3390/jcm11185330
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author Imamura, Teruhiko
Narang, Nikhil
Kinugawa, Koichiro
author_facet Imamura, Teruhiko
Narang, Nikhil
Kinugawa, Koichiro
author_sort Imamura, Teruhiko
collection PubMed
description Background: Sodium zirconium cyclosilicate (SZC), a newly introduced potassium binder, is indicated for treating hyperkalemia. SZC-incorporated up-titration of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists has been recommended for those with systolic heart failure, whereas SZC is often terminated following the improvement of hyperkalemia in real-world practice. We aimed to investigate the impact of SZC cessation on the recurrence of hyperkalemia. Methods: Patients with systolic heart failure, in whom SZC was discontinued following improvement in hyperkalemia, were studied and compared to those who had continued SZC. All patients were followed for one year or until August 2022. The recurrent rates of hyperkalemia were compared between the two groups. Results: A total of 30 patients (median age 83 years, 53% men, median left ventricular ejection fraction 42%) were included. The one-year cumulative incidence of recurrent hyperkalemia was 93% in the group who discontinued SZC versus 22% in those who continued SZC (p = 0.032). In the group where SZC was withdrawn, doses of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists were less up-titrated, echocardiographic evidence of reverse remodeling occurred less, and readmission due to worsening heart failure tended to be higher compared to those who remained on SZC therapy. Conclusions: SZC cessation was associated with recurrent hyperkalemia and suboptimal medical therapy optimization compared to continuation of SZC therapy.
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spelling pubmed-95046212022-09-24 Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure Imamura, Teruhiko Narang, Nikhil Kinugawa, Koichiro J Clin Med Article Background: Sodium zirconium cyclosilicate (SZC), a newly introduced potassium binder, is indicated for treating hyperkalemia. SZC-incorporated up-titration of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists has been recommended for those with systolic heart failure, whereas SZC is often terminated following the improvement of hyperkalemia in real-world practice. We aimed to investigate the impact of SZC cessation on the recurrence of hyperkalemia. Methods: Patients with systolic heart failure, in whom SZC was discontinued following improvement in hyperkalemia, were studied and compared to those who had continued SZC. All patients were followed for one year or until August 2022. The recurrent rates of hyperkalemia were compared between the two groups. Results: A total of 30 patients (median age 83 years, 53% men, median left ventricular ejection fraction 42%) were included. The one-year cumulative incidence of recurrent hyperkalemia was 93% in the group who discontinued SZC versus 22% in those who continued SZC (p = 0.032). In the group where SZC was withdrawn, doses of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists were less up-titrated, echocardiographic evidence of reverse remodeling occurred less, and readmission due to worsening heart failure tended to be higher compared to those who remained on SZC therapy. Conclusions: SZC cessation was associated with recurrent hyperkalemia and suboptimal medical therapy optimization compared to continuation of SZC therapy. MDPI 2022-09-10 /pmc/articles/PMC9504621/ /pubmed/36142977 http://dx.doi.org/10.3390/jcm11185330 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Imamura, Teruhiko
Narang, Nikhil
Kinugawa, Koichiro
Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure
title Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure
title_full Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure
title_fullStr Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure
title_full_unstemmed Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure
title_short Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure
title_sort impact of sodium zirconium cyclosilicate therapy cessation in patients with systolic heart failure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9504621/
https://www.ncbi.nlm.nih.gov/pubmed/36142977
http://dx.doi.org/10.3390/jcm11185330
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