Patiromer and Sodium Zirconium Cyclosilicate in Treatment of Hyperkalemia: A Systematic Review and Meta-Analysis

Dhan Bahadur Shrestha; Pravash Budhathoki; Yub Raj Sedhai; Ramkaji Baniya; Casey A Cable; Markos G Kashiouris; Dave L Dixon; Jason M Kidd; Yuvraj Adhikari; Anupama Marasini; Shakar Bhandari

doi:10.1016/j.curtheres.2021.100635

Patiromer and Sodium Zirconium Cyclosilicate in Treatment of Hyperkalemia: A Systematic Review and Meta-Analysis

Curr Ther Res Clin Exp. 2021 Jul 5:95:100635. doi: 10.1016/j.curtheres.2021.100635. eCollection 2021.

Authors

Affiliations

¹ Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois.
² Department of Internal Medicine, Bronxcare Health System, New York, NY.
³ Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia.
⁴ Department of Internal Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana.
⁵ Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia.
⁶ Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
⁷ Division of Nephrology, Department of Internal Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia.
⁸ Nepalese Army Institute of Health Sciences, Kathmandu, Nepal.

Abstract

Background: Patiromer and sodium zirconium cyclosilicate (SZC) are newer options for hyperkalemia treatment. This systematic review and meta-analysis were conducted to assess the safety and side effect profile of patiromer and SZC compared with placebo or other standards of care in the management of hyperkalemia.

Methods: We searched electronic databases for relevant articles. The screening was performed independently and data were extracted among the selected studies. We performed a statistical analysis on Revman 5.4 software. The odds ratio (OR) was used for outcome estimation with a 95% CI.

Results: Patiromer had lower rates of hyperkalemia (OR = 0.44; 95% CI, 0.22-0.89) compared with standard of care. The analysis showed no significant differences between the 2 groups in terms of overall adverse effects, any serious/specific adverse effects, or treatment discontinuation as a result of adverse effects. Comparing the SZC-10 group with standard of care showed no significant differences in the occurrence of hyperkalemia during treatment, overall adverse effects, any serious/specific adverse effects, or treatment discontinuation as a result of adverse effects but showed a higher rate of edema in the treatment group (OR = 6.77; 95% CI, 1.03-44.25). Similarly, no significant differences were seen between the 2 SZC doses for the occurrence of any adverse effects, hyperkalemia, constipation, diarrhea, or urinary tract infection, whereas edema was higher among patients receiving SZC-10 (OR = 3.13; 95% CI, 1.19-8.27).

Conclusions: In patients with acute hyperkalemia, SZC is the drug of choice due to its more rapid reduction of serum potassium level, whereas in patients with chronic hyperkalemia, patiromer appears to be the drug of choice because SZC is associated with an increase in edema, likely due to an increase in sodium absorption, which could have important adverse consequences in patients with chronic kidney disease and or heart failure. Thus, both drugs were found to be safe while treating hyperkalemia. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).

Keywords: hyperkalemia; patiromer; potassium; sodium zirconium cyclosilicate.

Publication types

Review