Lokelma (sodium zirconium cyclosilicate) / AstraZeneca - LARVOL DELTA

CARDIOVASCULAR ADVERSE EVENTS ASSOCIATED WITH SODIUM ZIRCONIUM CYCLOSILICATE: A FAERS ANALYSIS (CHEST 2026) - No abstract available

Adverse events • Cardiovascular

Evolving Pharmacological Management of Hyperkalemia: Insights for Nephrology Clinicians. (PubMed, Nephrol Nurs J) - "Oral potassium binders like sodium polystyrene sulfonate, patiromer, and sodium zirconium cyclosilicate play an important role in managing hyperkalemia. Nephrology nurses play a critical role in recognizing hyperkalemia, optimizing pharmacologic therapy, providing comprehensive patient education regarding management of hyperkalemia, and monitoring for side effects like gastrointestinal issues, hypomagnesemia, or edema. By mastering these pharmacological strategies and nursing considerations, clinicians ensure patient safety and the continued use of essential cardiorenal protective therapies."

Journal • Cardiovascular • Chronic Kidney Disease • Nephrology • Renal Disease

Beyond potassium lowering: interpreting an adaptive sodium zirconium cyclosilicate strategy in hemodialysis. (PubMed, Int Urol Nephrol) - No abstract available

Journal

KEEP-ON: Keeping RAASi Treatment With Optimal Potassium Control (clinicaltrials.gov) - P3 | N=78 | Recruiting | Sponsor: Fundación para la Investigación del Hospital Clínico de Valencia | Trial completion date: Jul 2026 ➔ Jul 2027 | Trial primary completion date: Jul 2025 ➔ Jul 2027

Trial completion date • Trial primary completion date • Chronic Kidney Disease • Nephrology • Renal Disease

Optimising cardiorenal care: enabling better patient outcomes (ESC 2026) - "Sponsored by AstraZeneca To discuss preliminary observations from the ongoing OPRA-HF study, evaluating the role of sodium zirconium cyclosilicate in facilitating magnetic resonance angiography optimisation through the management of hyperkalaemia in patients with HFrEF; To review cardiovascular outcomes after starting dapagliflozin in patients with heart failure across the healthcare settings (ambulatory and hospital), based on evidence from the DAPA TRIO heart failure meta analysis; and To integrate recent evidence to inform holistic and proactive cardiorenal management."

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure

Hyperkalaemia management 101: supporting renin-angiotensin-aldosterone system inhibitors optimisation (ESC 2026) - "Sponsored by AstraZeneca To describe real-world characteristics and treatment patterns in patients with hyperkalaemia following treatment with renin-angiotensin aldosterone system inhibitors; and To review clinical outcomes observed following initiation of sodium zirconium cyclosilicate in patients with chronic kidney disease and heart failure."

Cardiovascular • Congestive Heart Failure • Heart Failure

Hyperkalaemia management 101: supporting renin-angiotensin-aldosterone system inhibitor optimisation (ESC 2026) - "Sponsored by AstraZeneca To describe real-world characteristics and treatment patterns in patients with hyperkalaemia following treatment with renin-angiotensin aldosterone system inhibitors; and To review clinical outcomes observed following initiation of sodium zirconium cyclosilicate in patients with chronic kidney disease and heart failure."

Cardiovascular • Congestive Heart Failure • Heart Failure

Optimizing mineralocorticoid receptor antagonist therapy with sodium zirconium cyclosilicate in heart failure (ESC 2026) - "In patients with HFrEF, the use of SZC effectively enabled optimization of guideline-directed MRA treatment compared to placebo despite contemporary background heart failure therapy and a persistently high risk of hyperkalemia. Moreover SZC was well tolerated without incresing risk of heart failure events. This strategy may help bridge the gap between guideline recommendations and real-world clinical practice by mitigating hyperkalemia-related barriers to MRA use."

Cardiovascular • Congestive Heart Failure • Heart Failure

Safety of potassium-binding agents in HFrEF: a meta-analysis of randomized trials (ESC 2026) - "In this setting, potassium-binding agents such as patiromer and sodium zirconium cyclosilicate (SZC) have gained increasing attention, as they lower serum potassium through gastrointestinal cation exchange and may enable continuation of GDMT... In HFrEF, potassium-binding agents may worsen CV outcomes. The increased risk of hypokalemia may promote ventricular arrhythmias in an already vulnerable myocardium, while sodium exchange (particularly with SZC) may contribute to fluid retention and congestion. These mechanisms may help explain the observed increase in CV outcomes in this meta-analysis."

Retrospective data • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Heart Failure

Cardiovascular outcomes with potassium binders in patients with heart failure and hyperkalemia (ESC 2026) - "We aimed to compare cardiovascular outcomes associated with patiromer, sodium zirconium cyclosilicate (SZC), and sodium polystyrene sulfonate (SPS) using a target-trial emulation framework...SZC was associated with higher risks of HF and cardiovascular hospitalisation compared with both patiromer and SPS, while patiromer was associated with lower HF hospitalisation compared with SPS. These findings highlight that potassium binders are not interchangeable from a cardiovascular perspective and underscore the need for randomised trials specifically powered for hard cardiovascular endpoints."

Clinical • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Heart Failure • Myocardial Infarction • Ventricular Tachycardia

Short-Term Serious Intestinal Injury After Sodium Zirconium Cyclosilicate versus Sodium Polystyrene Sulfonate: A Propensity-Matched TriNetX Study (ACG 2026) - "Propensity-score matching used 5-year pre-index covariates: age, sex, race/ethnicity; chronic/end-stage kidney disease, dialysis, acute kidney injury, creatinine; diabetes, heart failure, peripheral vascular disease, malignancy; sepsis, shock/hypotension, ED/ICU encounters; bowel obstruction/ileus, constipation; renin-angiotensin inhibitors, diuretics, opioids, NSAIDs, aspirin/antiplatelets, and corticosteroids...Patiromer was not associated with increased 30-day injury versus SPS (RR 0.943, 95% CI 0.746-1.193; HR 0.936, 95% CI 0.739-1.184)... After matching and exclusion of prior outcome events, the 30-day analysis included 163,951 SZC users and 164,737 SPS users. Serious intestinal injury occurred in 795 versus 680 users. SZC was associated with higher 30-day injury risk (RR 1.175, 95% CI 1.061-1.301; HR 1.203, 95% CI 1.086-1.333)."

Acute Kidney Injury • Cardiovascular • Congestive Heart Failure • Conjunctivitis • Constipation • Diabetes • Diabetic Nephropathy • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Hypotension • Infectious Disease • Metabolic Disorders • Nephrology • Ocular Infections • Ocular Inflammation • Ophthalmology • Peripheral Arterial Disease • Renal Disease • Septic Shock

Liberal fruit and vegetable intake in patients with advanced CKD with or without Sodium zirconium cyclosilicate. (PubMed, J Ren Nutr) - "A potassium-rich diet was consistent with non-inferior serum potassium levels compared with a regular diet at 6 weeks in patients with advanced CKD receiving RAAS inhibition. Hyperkalemia occurred in a minority of patients, and was effectively managed with SZC, allowing continuation of both the diet and RAAS inhibition. These findings suggest that a potassium-rich diet may be feasible in selected patients with advanced CKD, with careful monitoring and use of SZC when needed."

Journal • Chronic Kidney Disease • Hypotension • Nephrology • Renal Disease

Radiopaque Intestinal Cast of Sodium Zirconium Cyclosilicate on CT. (PubMed, Kidney Int) - No abstract available

Journal

Sodium zirconium cyclosilicate for renin-angiotensin-aldosterone system inhibitor therapy optimization: A systematic review and meta-analysis with meta-regression. (PubMed, Nefrologia (Engl Ed)) - "SZC was associated with improved maintenance and optimization of RAASi therapy, while reducing the risk of down-titration or discontinuation. Randomized trials powered for cardiovascular and renal endpoints are needed to determine whether SZC use translates into improved patient outcomes."

Clinical • Journal • Retrospective data • Review • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Nephrology • Renal Disease

Optimizing hyperkalemia management in CKD: real-world nephrologist strategies and impact on patient outcomes. (PubMed, J Nephrol) - "Integrating potassium binders into CKD therapeutic strategies may improve hyperkalemia management and allow sustained RAASi/MRA use. Recurrence remains significant, impacting renal function, although causality is unclear. The mortality difference requires further study."

Journal • Real-world evidence • Cardiovascular • Chronic Kidney Disease • Diabetes • Hypertension • Metabolic Disorders • Nephrology • Renal Disease

The Unfulfilled Promise of Potassium Binding in Heart Failure With Reduced Ejection Fraction. (PubMed, J Am Coll Cardiol) - No abstract available

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

Severe Intra-Operative Hyperkalemia Following Discontinuation GLP-1 Among Patients On Long-term Therapy: A Case Report (ASA 2026) - "A 71-year-old male (ASA III) with CKD, obesity, and hypertension on long term GLP-1 who underwent elective T12-L2 decompressive laminectomy with fusion...Treatment included dextrose, insulin, albuterol, bicarbonate, and furosemide...Postoperatively, Lokelma was also administered. Creatinine peaked at 1.6 mg/dL and potassium at 5.6 mmol/L. By postoperative day two, values normalized."

Case report • Clinical • Cardiovascular • Chronic Kidney Disease • Genetic Disorders • Hypertension • Obesity

Effects of Sodium Zirconium Cyclosilicate on Volume Status in Maintenance Hemodialysis: Post Hoc Analysis from the DIALIZE-Outcomes Trial. (PubMed, Kidney360) - "In this post hoc analysis of a large trial of patients with hyperkalemia receiving hemodialysis, there was no clinical evidence of volume changes with SZC. This supports the use of SZC as hyperkalemia treatment among patients receiving hemodialysis-a population at high risk for hypervolemia."

Journal • Retrospective data • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypertension

Navigating the potassium dilemma: a qualitative study of nephrologists' strategies for renin-angiotensin-aldosterone system inhibitor preservation and hyperkalaemia management in Spain. (PubMed, PLoS One) - "Nephrologists in Spain prioritised preservation of RAASi therapy when managing hyperkalaemia in predialysis CKD. Although newer potassium binders supported this objective, their use was limited by access and care coordination challenges. Streamlined access pathways, improved multidisciplinary communication, and routine HRQoL assessments may enable more patient-centred and guideline-concordant care. These implications reflect qualitative clinician perspectives rather than evidence of clinical or economic effectiveness."

Journal • Chronic Kidney Disease • Nephrology • Renal Disease

Switching from Cation-Exchange Resin to Sodium Zirconium Cyclosilicate Hydrate in Patients on Hemodialysis. (PubMed, J Clin Med) - "These findings are consistent with the greater cation selectivity of SZC and suggest that replacement of conventional cation-exchange resins may contribute to preservation of serum magnesium concentrations. Further multicenter prospective studies evaluating magnesium metabolism together with clinically relevant outcomes are warranted to confirm these findings and clarify their clinical significance."

Journal

Management of hyperkalaemia in the Italian clinical practice: impact of diverse potassium binders on outcomes and costs in patients with chronic kidney disease and heart failure. (PubMed, Int Urol Nephrol) - "These findings suggest a patiromer potential role for sustained potassium binder therapy in supporting RAASi optimization and improving clinical management in routine practice, but confirmation through direct comparative prospective randomized trials is needed."

Journal • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Nephrology • Renal Disease

Efficacy and safety of sodium zirconium cyclosilicate on non-dialysis days for long-term management of chronic hyperkalemia in maintenance hemodialysis: a single-center, prospective, open-label, randomized controlled trial. (PubMed, Int Urol Nephrol) - P4 | "Under the conditions of this study, oral SZC on non-dialysis days produced a modest but statistically significant reduction in pre-dialysis serum potassium after LIDI and was generally tolerated. The exploratory clinical-event findings are hypothesis-generating and require confirmation in larger blinded multicenter trials."

Journal • Cardiovascular • Constipation • Gastroenterology • Gastrointestinal Disorder

Sodium zirconium cyclosilicate compared with potassium restriction for hyperkalemia management in type 2 diabetes: The SILVERSTAR trial. (PubMed, J Diabetes Investig) - "The trial did not meet its primary endpoint: noninferiority of sodium zirconium cyclosilicate to the potassium-restricted diet was not demonstrated in the full analysis set."

Journal • Diabetes • Metabolic Disorders • Type 2 Diabetes Mellitus

Sodium zirconium cyclosilicate post hospital discharge to prevent hyperkalaemia: phase 4, randomized CONTINUITY trial. (PubMed, Clin Kidney J) - "Study design limitations may have masked true treatment effects. Post hoc analyses revealed positive trends in SZC use and potential for reducing rehospitalization and enabling renin-angiotensin-aldosterone system inhibitor therapy continuation at optimal doses."

Journal • P4 data • Chronic Kidney Disease • Nephrology • Renal Disease

Identifying and Managing Hungry Bone Syndrome after A Total Parathyroidectomy (ENDO 2026) - "He received calcium gluconate intravenously, dextrose, regular insulin, sodium bicarbonate, and sodium zirconium cyclosilicate...The complexity of skeletal remodeling due to decreasing circulating PTH levels causing changes in calcium influx and efflux, severe hyperkalemia requiring urgent dialysis, and the challenge of calcium repletion in the setting of ESRD make this case noteworthy. This case highlights the crucial need for vigilant monitoring and aggressive supplementation of electrolytes after a parathyroidectomy."

Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Dyslipidemia • Endocrine Disorders • Genetic Disorders • Heart Failure • Hypertension • Nephrology • Obesity • Renal Disease