Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis
Background Sodium zirconium cyclosilicate (SZC), an ion-exchange resin, is effective in the control of hyperkalemia in adults with chronic kidney disease (CKD); reports of use in children are limited. Prolonged therapy with SZC to relax dietary potassium restriction in CKD has not been examined. Met...
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| Veröffentlicht in: | Pediatric nephrology (Berlin, West) West), 2024-04, Vol.39 (4), p.1213-1219 |
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| creator | Khandelwal, Priyanka Shah, Sarit McAlister, Louise Cleghorn, Shelley King, Lillian Shroff, Rukshana |
| description | Background
Sodium zirconium cyclosilicate (SZC), an ion-exchange resin, is effective in the control of hyperkalemia in adults with chronic kidney disease (CKD); reports of use in children are limited. Prolonged therapy with SZC to relax dietary potassium restriction in CKD has not been examined.
Methods
We conducted a retrospective chart review of patients 6 months to 18 years of age with CKD stage 4–5 or on dialysis (5D) administered SZC for sustained hyperkalemia (potassium ≥ 5.5 mEq/L, three consecutive values). Patients received SZC (0.5–10 g per dose; age-based) either short-term ( 30 days).
Results
Twenty patients with median age 10.8 (inter-quartile range 3.9, 13.4) years were treated with SZC. Short-term SZC, for 5 (3, 19) days, was associated with safe management of dialysis catheter insertions (
n
= 5) and access dysfunction (
n
= 4), and was useful during palliative care (
n
= 1). Serum potassium levels decreased from 6.7 (6.1, 6.9) to 4.4 (3.7, 5.2) mEq/L (
P
|
| doi_str_mv | 10.1007/s00467-023-06176-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2880103468</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2880103468</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-87cfe4cd2f3c02b3cd7560a9b7e7f274b5a1e680deff4cb7205600eddcf4486b3</originalsourceid><addsrcrecordid>eNp9kU1u1TAUhSMEoo_CBhggS0yYBK5_YidDVPEnVWIASJ1Zjn3d5zZxHnaiKoy6h26CdbES_PpKkRgwsnXPd861darqOYXXFEC9yQBCqhoYr0FSJWv5oNpQwVlNu_bsYbWBjtMaBD07qp7kfAEAbdPKx9URV22jOmg21c8vxuO8EhMdQe-DNXYlkyd5cmEZyY-Q7BT3N7vaYcphKMSMxE-JzFsko4nmHEeM895k7FK0fZTdpmKzZLvuMF2aAcdgSIhlHgaXMJKrMG_vqcvgIq7EhYwmIxG_rm-a25gplqEZ1hzy0-qRN0PGZ3fncfXt_buvJx_r088fPp28Pa0tV81ct8p6FNYxzy2wnlunGgmm6xUqz5ToG0NRtuDKZ4XtFYMiAzpnvRCt7Plx9eqQu0vT9wXzrMeQLQ6DiTgtWbO2BQpcyLagL_9BL6YlxfI6zTrORAcd7Cl2oGyack7o9S6F0aRVU9D7HvWhR1161Lc9allML-6il35Ed2_5U1wB-AHIRYrnmP7u_k_sbzF5rPs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2932490908</pqid></control><display><type>article</type><title>Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis</title><source>Springer Nature - Complete Springer Journals</source><creator>Khandelwal, Priyanka ; Shah, Sarit ; McAlister, Louise ; Cleghorn, Shelley ; King, Lillian ; Shroff, Rukshana</creator><creatorcontrib>Khandelwal, Priyanka ; Shah, Sarit ; McAlister, Louise ; Cleghorn, Shelley ; King, Lillian ; Shroff, Rukshana</creatorcontrib><description>Background
Sodium zirconium cyclosilicate (SZC), an ion-exchange resin, is effective in the control of hyperkalemia in adults with chronic kidney disease (CKD); reports of use in children are limited. Prolonged therapy with SZC to relax dietary potassium restriction in CKD has not been examined.
Methods
We conducted a retrospective chart review of patients 6 months to 18 years of age with CKD stage 4–5 or on dialysis (5D) administered SZC for sustained hyperkalemia (potassium ≥ 5.5 mEq/L, three consecutive values). Patients received SZC (0.5–10 g per dose; age-based) either short-term (< 30 days) or long-term (> 30 days).
Results
Twenty patients with median age 10.8 (inter-quartile range 3.9, 13.4) years were treated with SZC. Short-term SZC, for 5 (3, 19) days, was associated with safe management of dialysis catheter insertions (
n
= 5) and access dysfunction (
n
= 4), and was useful during palliative care (
n
= 1). Serum potassium levels decreased from 6.7 (6.1, 6.9) to 4.4 (3.7, 5.2) mEq/L (
P
< 0.001). Long-term SZC for 5.3 (4.2, 10.1) months achieved decline in serum potassium from 6.1 (5.8, 6.4) to 4.8 (4.2, 5.4) mEq/L (
P
< 0.001). SZC use was associated with liberalization of diet (
n
= 6) and was useful in patients with poor adherence to dietary restriction (
n
= 3). Adverse events or edema were not observed; serum sodium and blood pressure remained stable.
Conclusions
SZC was safe and effective for the management of acute and chronic hyperkalemia in children with CKD4-5/5D. Its use was associated with relaxation of dietary potassium restriction. Studies to examine its routine use to improve diet and nutritional status in children with CKD are required.
Graphical Abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information</description><identifier>ISSN: 0931-041X</identifier><identifier>EISSN: 1432-198X</identifier><identifier>DOI: 10.1007/s00467-023-06176-6</identifier><identifier>PMID: 37857905</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age ; Blood pressure ; Children ; Dialysis ; Dietary restrictions ; Edema ; Hemodialysis ; Hyperkalemia ; Kidney diseases ; Medicine ; Medicine & Public Health ; Nephrology ; Nutritional status ; Original Article ; Pediatrics ; Potassium ; Sodium ; Urology ; What's New in Dialysis</subject><ispartof>Pediatric nephrology (Berlin, West), 2024-04, Vol.39 (4), p.1213-1219</ispartof><rights>The Author(s), under exclusive licence to International Pediatric Nephrology Association 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-87cfe4cd2f3c02b3cd7560a9b7e7f274b5a1e680deff4cb7205600eddcf4486b3</citedby><cites>FETCH-LOGICAL-c375t-87cfe4cd2f3c02b3cd7560a9b7e7f274b5a1e680deff4cb7205600eddcf4486b3</cites><orcidid>0000-0001-8501-1072</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00467-023-06176-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00467-023-06176-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37857905$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khandelwal, Priyanka</creatorcontrib><creatorcontrib>Shah, Sarit</creatorcontrib><creatorcontrib>McAlister, Louise</creatorcontrib><creatorcontrib>Cleghorn, Shelley</creatorcontrib><creatorcontrib>King, Lillian</creatorcontrib><creatorcontrib>Shroff, Rukshana</creatorcontrib><title>Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis</title><title>Pediatric nephrology (Berlin, West)</title><addtitle>Pediatr Nephrol</addtitle><addtitle>Pediatr Nephrol</addtitle><description>Background
Sodium zirconium cyclosilicate (SZC), an ion-exchange resin, is effective in the control of hyperkalemia in adults with chronic kidney disease (CKD); reports of use in children are limited. Prolonged therapy with SZC to relax dietary potassium restriction in CKD has not been examined.
Methods
We conducted a retrospective chart review of patients 6 months to 18 years of age with CKD stage 4–5 or on dialysis (5D) administered SZC for sustained hyperkalemia (potassium ≥ 5.5 mEq/L, three consecutive values). Patients received SZC (0.5–10 g per dose; age-based) either short-term (< 30 days) or long-term (> 30 days).
Results
Twenty patients with median age 10.8 (inter-quartile range 3.9, 13.4) years were treated with SZC. Short-term SZC, for 5 (3, 19) days, was associated with safe management of dialysis catheter insertions (
n
= 5) and access dysfunction (
n
= 4), and was useful during palliative care (
n
= 1). Serum potassium levels decreased from 6.7 (6.1, 6.9) to 4.4 (3.7, 5.2) mEq/L (
P
< 0.001). Long-term SZC for 5.3 (4.2, 10.1) months achieved decline in serum potassium from 6.1 (5.8, 6.4) to 4.8 (4.2, 5.4) mEq/L (
P
< 0.001). SZC use was associated with liberalization of diet (
n
= 6) and was useful in patients with poor adherence to dietary restriction (
n
= 3). Adverse events or edema were not observed; serum sodium and blood pressure remained stable.
Conclusions
SZC was safe and effective for the management of acute and chronic hyperkalemia in children with CKD4-5/5D. Its use was associated with relaxation of dietary potassium restriction. Studies to examine its routine use to improve diet and nutritional status in children with CKD are required.
Graphical Abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information</description><subject>Age</subject><subject>Blood pressure</subject><subject>Children</subject><subject>Dialysis</subject><subject>Dietary restrictions</subject><subject>Edema</subject><subject>Hemodialysis</subject><subject>Hyperkalemia</subject><subject>Kidney diseases</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nephrology</subject><subject>Nutritional status</subject><subject>Original Article</subject><subject>Pediatrics</subject><subject>Potassium</subject><subject>Sodium</subject><subject>Urology</subject><subject>What's New in Dialysis</subject><issn>0931-041X</issn><issn>1432-198X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kU1u1TAUhSMEoo_CBhggS0yYBK5_YidDVPEnVWIASJ1Zjn3d5zZxHnaiKoy6h26CdbES_PpKkRgwsnXPd861darqOYXXFEC9yQBCqhoYr0FSJWv5oNpQwVlNu_bsYbWBjtMaBD07qp7kfAEAbdPKx9URV22jOmg21c8vxuO8EhMdQe-DNXYlkyd5cmEZyY-Q7BT3N7vaYcphKMSMxE-JzFsko4nmHEeM895k7FK0fZTdpmKzZLvuMF2aAcdgSIhlHgaXMJKrMG_vqcvgIq7EhYwmIxG_rm-a25gplqEZ1hzy0-qRN0PGZ3fncfXt_buvJx_r088fPp28Pa0tV81ct8p6FNYxzy2wnlunGgmm6xUqz5ToG0NRtuDKZ4XtFYMiAzpnvRCt7Plx9eqQu0vT9wXzrMeQLQ6DiTgtWbO2BQpcyLagL_9BL6YlxfI6zTrORAcd7Cl2oGyack7o9S6F0aRVU9D7HvWhR1161Lc9allML-6il35Ed2_5U1wB-AHIRYrnmP7u_k_sbzF5rPs</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Khandelwal, Priyanka</creator><creator>Shah, Sarit</creator><creator>McAlister, Louise</creator><creator>Cleghorn, Shelley</creator><creator>King, Lillian</creator><creator>Shroff, Rukshana</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8501-1072</orcidid></search><sort><creationdate>20240401</creationdate><title>Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis</title><author>Khandelwal, Priyanka ; Shah, Sarit ; McAlister, Louise ; Cleghorn, Shelley ; King, Lillian ; Shroff, Rukshana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-87cfe4cd2f3c02b3cd7560a9b7e7f274b5a1e680deff4cb7205600eddcf4486b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Age</topic><topic>Blood pressure</topic><topic>Children</topic><topic>Dialysis</topic><topic>Dietary restrictions</topic><topic>Edema</topic><topic>Hemodialysis</topic><topic>Hyperkalemia</topic><topic>Kidney diseases</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nephrology</topic><topic>Nutritional status</topic><topic>Original Article</topic><topic>Pediatrics</topic><topic>Potassium</topic><topic>Sodium</topic><topic>Urology</topic><topic>What's New in Dialysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khandelwal, Priyanka</creatorcontrib><creatorcontrib>Shah, Sarit</creatorcontrib><creatorcontrib>McAlister, Louise</creatorcontrib><creatorcontrib>Cleghorn, Shelley</creatorcontrib><creatorcontrib>King, Lillian</creatorcontrib><creatorcontrib>Shroff, Rukshana</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric nephrology (Berlin, West)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khandelwal, Priyanka</au><au>Shah, Sarit</au><au>McAlister, Louise</au><au>Cleghorn, Shelley</au><au>King, Lillian</au><au>Shroff, Rukshana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis</atitle><jtitle>Pediatric nephrology (Berlin, West)</jtitle><stitle>Pediatr Nephrol</stitle><addtitle>Pediatr Nephrol</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>39</volume><issue>4</issue><spage>1213</spage><epage>1219</epage><pages>1213-1219</pages><issn>0931-041X</issn><eissn>1432-198X</eissn><abstract>Background
Sodium zirconium cyclosilicate (SZC), an ion-exchange resin, is effective in the control of hyperkalemia in adults with chronic kidney disease (CKD); reports of use in children are limited. Prolonged therapy with SZC to relax dietary potassium restriction in CKD has not been examined.
Methods
We conducted a retrospective chart review of patients 6 months to 18 years of age with CKD stage 4–5 or on dialysis (5D) administered SZC for sustained hyperkalemia (potassium ≥ 5.5 mEq/L, three consecutive values). Patients received SZC (0.5–10 g per dose; age-based) either short-term (< 30 days) or long-term (> 30 days).
Results
Twenty patients with median age 10.8 (inter-quartile range 3.9, 13.4) years were treated with SZC. Short-term SZC, for 5 (3, 19) days, was associated with safe management of dialysis catheter insertions (
n
= 5) and access dysfunction (
n
= 4), and was useful during palliative care (
n
= 1). Serum potassium levels decreased from 6.7 (6.1, 6.9) to 4.4 (3.7, 5.2) mEq/L (
P
< 0.001). Long-term SZC for 5.3 (4.2, 10.1) months achieved decline in serum potassium from 6.1 (5.8, 6.4) to 4.8 (4.2, 5.4) mEq/L (
P
< 0.001). SZC use was associated with liberalization of diet (
n
= 6) and was useful in patients with poor adherence to dietary restriction (
n
= 3). Adverse events or edema were not observed; serum sodium and blood pressure remained stable.
Conclusions
SZC was safe and effective for the management of acute and chronic hyperkalemia in children with CKD4-5/5D. Its use was associated with relaxation of dietary potassium restriction. Studies to examine its routine use to improve diet and nutritional status in children with CKD are required.
Graphical Abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37857905</pmid><doi>10.1007/s00467-023-06176-6</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8501-1072</orcidid></addata></record> |
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| ispartof | Pediatric nephrology (Berlin, West), 2024-04, Vol.39 (4), p.1213-1219 |
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| source | Springer Nature - Complete Springer Journals |
| subjects | Age Blood pressure Children Dialysis Dietary restrictions Edema Hemodialysis Hyperkalemia Kidney diseases Medicine Medicine & Public Health Nephrology Nutritional status Original Article Pediatrics Potassium Sodium Urology What's New in Dialysis |
| title | Safety and efficacy of sodium zirconium cyclosilicate for the management of acute and chronic hyperkalemia in children with chronic kidney disease 4–5 and on dialysis |
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