Lokelma (sodium zirconium cyclosilicate) / AstraZeneca - LARVOL DELTA

Prolonged Gastric Retention of Sodium Zirconium Cyclosilicate: A Case Report. (PubMed, Cureus) - "This case highlights that prolonged gastric retention of SZC can occur, potentially increasing the risk of complications. We recommend monitoring the passage of orally administered SZC with imaging studies to prevent such occurrences."

Journal • Acute Kidney Injury • Nephrology • Renal Disease

Managing Hyperkalemia in Heart Failure Patients: A Systematic Review. (PubMed, Cardiol Rev) - "For chronic management, newer potassium-binding agents such as patiromer and sodium zirconium cyclosilicate offer improved safety and efficacy compared with traditional resins, enabling the continuation and up-titration of renin-angiotensin-aldosterone system inhibitors. These therapies support optimal neurohormonal blockade, improve adherence, and reduce morbidity and mortality in heart failure."

Journal • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Heart Failure • Metabolic Disorders • Nephrology • Renal Disease

An Antifungal Tradeoff: A Case of Adrenal Insufficiency from Long-Term Fluconazole Treatment of Coccidiomycosis (KIDNEY WEEK 2025) - "While posaconazole and itraconazole can cause adrenal steroidogenesis leading to pseudohyperaldosteronism, ketoconazole is most frequently reported azole to cause primary adrenal insufficiency by inhibiting 11b-hydroxylase and 17a hydroxylase enzymes responsible for the production of cortisol...He received insulin, dextrose, calcium gluconate, albuterol inhaler, and sodium zirconium cyclosilicate for his hyperkalemia...After clinical diagnosis of primary adrenal insufficiency, hydrocortisone 10 mg BID and fludrocortisone 0.1 mg was inititated daily...Chronic exposure to high doses of fluconazole could potentially impair cortisol synthesis through inhibition of steroidogenic enzymes leading to primary adrenal insuffiency. We believe it is important to bring awareness of this underrecognized risk to prevent delayed diagnosis and management."

Clinical • Cardiovascular • Dermatology • Endocrine Disorders • Hypertension • Metabolic Disorders • Nephrology • Renal Disease • Respiratory Diseases

Potassium Is Not So Scary (Anymore): First Experiences with Sodium Zirconium Cyclosilicate in Croatia (KIDNEY WEEK 2025) - "Conclusion SZC is the first available alternative to CPS in Croatia. It was well tolerated by all CKD patients ensuring improved and adequate control of potassium levels thus reducing the risk of hyperkalemia."

Cardiovascular • Chronic Kidney Disease • Diabetes • Metabolic Disorders • Pulmonary Arterial Hypertension • Type 2 Diabetes Mellitus

Hyperkalemia Following High-Dose Arginine Therapy in Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes: A Metabolic Consequence of Cationic Amino Acid Infusion (KIDNEY WEEK 2025) - "Management included two doses of sodium zirconium cyclosilicate, IV furosemide, and sodium bicarbonate, which lowered K+ transiently to 5.3 mEq/L before rebounding to 5.8...While previously observed in uremic patients, our case suggests that even those with preserved renal function may be susceptible. Clinicians should monitor potassium levels closely during arginine therapy to prevent this serious complication."

Cardiovascular • CNS Disorders • Epilepsy • Metabolic Disorders • Otorhinolaryngology

Comparative Efficacy of Sodium Zirconium Cyclosilicate vs. Conventional Therapy for Hyperkalemia: First Brazilian Cohort (KIDNEY WEEK 2025) - "Patients receiving conventional therapy (polarizing solution, furosemide, calcium gluconate, and/or bicarbonate) were compared with those treated with SZC. Diabetes was independent risk factor for persistent hyperkalaemia (OR: 2.77; 95% CI: 1.12–6.85; p: 0.027). Conclusion SZC was effective in reducing the persistence of hyperkalaemia compared to conventional therapy, even after adjustment for clinical factors."

Clinical • Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Heart Failure • Hypertension • Metabolic Disorders • Nephrology • Renal Disease

Effects of Sodium Zirconium Cyclosilicate on Volume Status in Hemodialysis: Post Hoc Analysis from the DIALIZE Outcomes Trial (KIDNEY WEEK 2025) - "Table. Events related to volume status in patients on hemodialysis with hyperkalemia SZC, sodium zirconium cyclosilicate."

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

Strategies for hyperkalemia management in dialysis patients: A systematic review. (PubMed, Open Med (Wars)) - "The aim of this systematic review is to evaluate current therapeutic strategies for hyperkalemia in dialysis patients, including diuretics, ion-exchange resins, and newer agents such as sodium zirconium cyclosilicate (SZC)...New therapies like SZC and patiromer demonstrated efficacy in maintaining safe potassium levels...Hyperkalemia management in dialysis patients benefits from an integrated approach combining pharmacologic treatment, tailored nutrition, and close monitoring. Novel interventions and evolving dietary guidelines may improve safety, effectiveness, and quality of life in this vulnerable population."

Journal • Review • Chronic Kidney Disease • Nephrology • Renal Disease

Economic Evaluation of Sodium Zirconium Cyclosilicate Lokelma for Treating Hyperkalemia in Patients With Heart Failure and/or Chronic Kidney Disease in Egypt (ISPOR-EU 2025) - "For CKD and HF patients with hyperkalaemia, SZC offers a cost-effective option from the Egyptian national payer perspective. Over a 20-year horizon, improved survival and reduced HK-related hospitalizations offset the acquisition cost."

Clinical • HEOR • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Nephrology • Renal Disease

Effect of Sodium Zirconium Cyclosilicate on the Burden of Hyperkalemia in Patients With End-Stage Renal Disease in Mexico (ISPOR-EU 2025) - "SZC substantially reduces the economic burden of hyperkalemia in ESRD patients by lowering rates of cardiovascular events and hospitalizations. From the perspective of the Mexican Health System, SZC represents a cost-saving strategy for managing hyperkalemia in this high-risk population."

Clinical • Cardiovascular • Chronic Kidney Disease • Nephrology • Renal Disease

Cost-Effectiveness of Sodium Zirconium Cyclosilicate for the Treatment of Hyperkalemia in Patients With End-Stage Renal Disease in Mexico (ISPOR-EU 2025) - "SZC reduces the incidence of CV events and hospitalisations while lowering overall treatment costs. From the MHS perspective, SZC is a robust treatment option for hyperkalemia in ESRD patients, offering both improved outcomes and cost saving."

Clinical • Cost effectiveness • HEOR • Chronic Kidney Disease • Nephrology • Renal Disease

Improving the Analysis of KCCQ Endpoints in Heart Failure Clinical Trials. (PubMed, Ther Innov Regul Sci) - "Conventional analyses of treatment effects on overall mean KCCQ score changes lead to misinterpretations in clinical trials, but this can be mitigated by using methods allowing for baseline-dependent effects."

Journal • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Heart Failure

Safety of Sodium Zirconium Cyclosilicate in Critically Ill Patients With Impaired Gastric Motility: A Case of Persistent Intragastric Precipitation. (PubMed, Cureus) - "Close radiographic monitoring of SZC transit is recommended for early detection. Further research is required to establish optimal management strategies for such adverse events."

Journal • Cardiovascular • Gastrointestinal Disorder • Nephrology • Renal Disease

Sodium Zirconium Cyclosilicate Duration and Hyperkalemia-Related Healthcare Encounters in Patients with Heart Failure and Cardio/Renal Dysfunction: The GALVANIZE Outcome Study. (PubMed, Drugs Real World Outcomes) - "Long-term SZC use is associated with significant reductions in hyperkalemia-related hospitalizations or emergency department visits compared with short-term use among patients with heart failure or cardio/renal dysfunction."

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

HYPERKALEMIA STRIKES: TRANSIENT PARALYSIS IN ESRD (CHEST 2025) - "She was discharged on sodium zirconium cyclosilicate with arrangements for close nephrology follow-up... Early recognition of hyperkalemia as a cause of acute flaccid paralysis in ESRD patients is crucial. Prompt diagnosis and treatment prevent life-threatening complications. Clinicians should consider metabolic causes in neurological deficits."

Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Coronary Artery Disease • Heart Failure • Nephrology • Renal Disease

REFRACTORY HYPERKALEMIA WITH STATUS ASTHMATICUS (CHEST 2025) - "CASE PRESENTATION: A 31-year-old-man with severe persistent asthma on Symbicort and albuterol presented to the emergency department with shortness of breath...Shortly after admission to the Intensive Care Unit, the patient developed an acute kidney injury (serum creatinine of 1.76) and hyperkalemia (6.1) refractory to medication intervention (including continuous albuterol, IV insulin with dextrose, sodium zirconium cyclosilicate) for which nephrology was consulted... The patient in this case most likely had hyperkalemia due to ATN which was exacerbated by elevated CK, drug use, severe respiratory acidosis, and possibly increased alpha adrenergic activity in the setting of albuterol. The mild degree of this patient's acute renal failure alone cannot explain his level of hyperkalemia."

Acute Kidney Injury • Asthma • Cardiovascular • Hypertension • Hypotension • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Renal Disease • Respiratory Diseases

Evaluation of sodium zirconium cyclosilicate usage for hyperkalaemia secondary to sulfamethoxazole/trimethoprim therapy. (PubMed, J Antimicrob Chemother) - "Sodium zirconium cyclosilicate was efficacious at lowering elevated potassium in patients receiving sulfamethoxazole/trimethoprim therapy without inducing hypokalaemia. This suggests sodium zirconium cyclosilicate may be considered in patients with treatment-limiting hyperkalaemia due to sulfamethoxazole/trimethoprim, especially when sulfamethoxazole/trimethoprim is preferred therapy."

Journal • Chronic Kidney Disease • Infectious Disease • Nephrology • Pneumonia • Renal Disease • Respiratory Diseases

Impact of Potassium-Binders on the Interpretation of Bone Mineral Density Following Kidney Transplantation. (PubMed, Clin Transplant) - "The potassium lowering drug sodium zirconium cyclosilicate (Lokelma) is radiopaque and therefore acts as a confounder on DXA interpretations in kidney transplant recipients. Patiromer (PAT, Veltassa) has no such effect."

Journal • Gastrointestinal Disorder • Transplantation

Real-world study of adverse events associated with sodium zirconium cyclosilicate based on FDA adverse event reporting system and VigiAccess database. (PubMed, PLoS One) - "Signals of cardiac disorders such as cardiac failure chronic, cardiac failure and cardiac failure congestive, signals of gastrointestinal disorders such as ileus and intestinal perforation, and signals of blood sodium increased and hypernatraemia are positive signals that deserve special attention. In this study, the common ADEs associated with SZC were confirmed, and several intriguing novel signals not included in the drug instructions were discovered, which would provide more safety reference data for the clinical use of SZC."

Adverse events • Journal • Real-world evidence • Cardiovascular • Congestive Heart Failure • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Infectious Disease • Myocardial Infarction • Pneumonia • Pulmonary Disease • Respiratory Diseases

Comparative effectiveness of sodium zirconium cyclosilicate versus calcium polystyrene sulfonate for patients with heart failure. (PubMed, Heart Vessels) - "Mineralocorticoid receptor antagonists (MRA) continuation was more frequent in the SZC group [70.1% vs. 59.0%, weighted odds ratio, 1.39 (95% CI 1.11-1.75)]. These findings suggest that although SZC may not improve survival or overall cardiovascular outcomes, it may help maintain essential HF therapies such as MRA."

HEOR • Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

Effects of sodium zirconium cyclosilicate on the quality of life of patients with hyperkalemia undergoing hemodialysis: Y-QOL study design. (PubMed, BMC Nephrol) - "Recruitment began on January 24, 2024, and the study will conclude on March 31, 2026. The Y-QOL study aims to determine the effectiveness of SZC in improving QOL by reducing serum potassium levels in patients with hyperkalemia undergoing HD."

Clinical protocol • HEOR • Journal • Inflammation

BRASH Phenomenon: A Case Report on the Dangerous Combination of Bradycardia, Acute Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia. (PubMed, Cureus) - "The patient's home medications included carvedilol and apixaban (due to non-compliance with warfarin)...These results prompted immediate treatment with intravenous calcium gluconate and an insulin-dextrose infusion, along with oral sodium zirconium cyclosilicate and albuterol nebulization...She was discharged home with initiation of outpatient dialysis.  Early recognition of BRASH syndrome is crucial because its management differs significantly from the standard Advanced Cardiovascular Life Support (ACLS) bradycardia algorithm. Unlike the standard approach, therapy for BRASH syndrome extends beyond atropine and electrolyte correction to potentially include hemodynamic vasopressor support, temporary transcutaneous pacing, and urgent renal replacement therapy."

Journal • Acute Kidney Injury • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Critical care • Nephrology • Renal Disease

Where next for potassium binders in hemodialysis? (PubMed, Kidney Int) - "The DIALIZE-Outcomes trial was designed to investigate whether the oral potassium binder, sodium zirconium cyclosilicate, could reduce cardiovascular events...From the available data, no difference in outcomes was observed, despite better potassium control. We discuss the strengths and limitations of the trial and highlight considerations for future studies."

Journal • Cardiovascular

Differences in Efficacy Among New and Old Potassium Binders in Dialysis Patients: A Systematic Review and Meta-Analysis. (PubMed, G Ital Nefrol) - "Newer potassium binders, patiromer and sodium zirconium cyclosilicate (SZC), offer improved tolerability compared to older agents. The lack of sufficient RCTs, especially those directly comparing newer binders, highlights a significant knowledge gap. Further studies are needed to evaluate long-term outcomes, including quality of life and cardiovascular effects, and to directly compare the efficacy and safety of different potassium binders in this population."

Clinical • Journal • Retrospective data • Review • Cardiovascular

Adverse drug events associated with sodium zirconium cyclosilicate: A real-world pharmacovigilance study based on the FAERS database. (PubMed, PLoS One) - "This study highlights both previously recognized and potentially novel adverse event signals associated with SZC, particularly during the early phase of treatment. While limited by the inherent constraints of spontaneous reporting systems-such as underreporting and missing data-our findings suggest that clinicians may consider closer monitoring of metabolic, renal, and cardiac adverse events during initial therapy. Observed early signals merit further validation in prospective studies, while long-term risks remain to be clarified."

Adverse events • Journal • Real-world evidence • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypertension