Lokelma (sodium zirconium cyclosilicate) / AstraZeneca - LARVOL DELTA

A HIDDEN HAZARD OF HEPARIN: LIFE-THREATENING HYPONATREMIA AND HYPERKALEMIA DUE TO TYPE IV RTA (ISN-WCN 2026) - "He subsequently received unfractionated heparin for thromboprophylaxis and dexamethasone for cord compression...Hypertonic saline, sodium zirconium cyclosilicate, and fludrocortisone were administered, and heparin, lisinopril, and hydrochlorothiazide were discontinued, resulting in rapid normalization of serum sodium, potassium, bicarbonate, and blood pressure.Results Download: Download high-res image (159KB)Download: Download full-size imageConclusion Although heparin associated Type 4 RTA is a well-known pharmacologic effect, its clinical impact is often underestimated...This case highlights that even routine heparin prophylaxis can cause severe aldosterone deficiency. Prompt recognition and discontinuation of heparin, along with temporary mineralocorticoid replacement, can be lifesaving."

Cardiovascular • Cognitive Disorders • Endocrine Disorders • Genito-urinary Cancer • Heart Failure • Hypertension • Metabolic Disorders • Nephrology • Prostate Cancer • Renal Disease • Solid Tumor

SODIUM ZIRCONIUM CYCLOSILICATE (SZC), A TREATMENT FOR HYPERKALEMIA, REMAINING IN THE STOMACH AND REQUIRING ENDOSCOPIC REMOVAL IN ELDERLY FEMALE. (ISN-WCN 2026) - "The use of SZC is expected to increase, as it is generally considered to be safe, even in the patients with a history of ileus. This case suggests that potential for gastric retention should be taken into account when administering SZC to patients with compromised gastrointestinal motility.Presented at: This abstract was also presented at the 255th Tokai Regional Meeting of the Japanese Society of Internal Medicine."

Clinical • Alzheimer's Disease • CNS Disorders • Dementia • Infectious Disease • Novel Coronavirus Disease • Pneumonia • Pulmonary Disease • Respiratory Diseases

Industry Symposium 56: The significance of potassium management in CKD treatment (ISN-WCN 2026) - "・Consider appropriate therapeutic options for hyperkalemia in CKD patients. ・Understand the product information and clinical trial evidence for LOKELMA (sodium zirconium cyclosilicate)."

Chronic Kidney Disease • Nephrology • Renal Disease

RAAS Inhibitor‑Stratified Efficacy of Sodium Zirconium Cyclosilicate vs. Potassium‑Restricted Diet and Nutritional Trade‑Offs in Type 2 Diabetes: A SILVERSTAR Subanalysis (ADA 2026) - "Available on Friday, May 29, 2026 at 12:00am CDT."

Clinical • Diabetes • Metabolic Disorders • Type 2 Diabetes Mellitus

Current primary care management of patients with hyperkalemia in Germany - Findings on monitoring, diagnosis, and treatment of elevated potassium levels (PubMed, Dtsch Med Wochenschr) - "Only 10.9% (n=76) of them were treated with potassium binders, and only 15.8% (n=12) of them received modern agents such as sodium zirconium cyclosilicate or patiromer.The management of hyperkalemia in high-risk patients in German primary care should be significantly improved through more frequent potassium monitoring and guideline-directed use of potassium binders to enhance patient outcomes. Furthermore, exploring the reasons behind the cautious use of medication to treat hyperkalemia may provide valuable insights."

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

EFFICACY AND SAFETY OF SODIUM ZIRCONIUM CYCLOSILICATE IN HYPERKALEMIA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. (ACC 2026) - "SZC effectively achieves normokalemia with acceptable safety, though higher doses raise hypokalemia risk. These findings support its role in hyperkalemia management and in enabling optimal RAASi therapy."

Retrospective data • Review • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Heart Failure • Metabolic Disorders • Nephrology • Renal Disease

ROLE OF NOVEL POTASSIUM BINDERS ON THE OPTIMIZATION OF GUIDELINE-DIRECTED MEDICAL THERAPY (GDMT) IN CHF PATIENTS (ACC 2026) - "Novel potassium binders (NPB), including patiromer and sodium zirconium cyclosilicate (SZC), have emerged as strategies to enable continued and optimized RAASi therapy. Our findings suggest that NPBs enable GDMT optimization, with minimal side effects. To better understand the efficacy and safety, a large-scale trial is warranted."

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

The implementation of a supplementary prescriber kidney dietitian in a dialysis unit. (UKKW 2026) - "The most common POMs assessments included: calcimimetics (oral and intravenous), phosphate binders, vitamin D analogues, sodium zirconium cyclosilicate, followed by dialysate changes, phosphate enema, pancreatin enzyme therapy and intra-dialytic parenteral nutrition...A disadvantage of this practice is the dietitians cannot become an independent prescribers, and the SP role comes with a significant amount of administrative work, linked to the implementation and annual review of the CMP. If dietitians were able to be independent prescribers this annual administrative work would be circumvented, saving time that could then be spent with patients."

Chronic Kidney Disease • Nephrology • Orthopedics

Optimizing Hyperkalaemia Management in Haemodialysis: The Role of Potassium Binders and Dietetic Involvement (UKKW 2026) - "NICE guidelines recommend dietary advice in conjunction with pharmacological treatment, with patiromer or sodium zirconium cyclosilicate (SZC) permitted in the UK only when persistent hyperkalaemia is confirmed at potassium ≥6.0 mmol/l. Potassium binders effectively reduced serum potassium, yet sustained control was achieved in only 59% of patients after six months, reflecting challenges with adherence, monitoring, prescription continuity, or binder efficacy. Dietitian involvement was associated with marked early improvements, reinforcing the importance of dietary support. However, the rebound in potassium highlights the need for structured follow-up, repeated reinforcement, and consideration of patient health literacy to support long-term behaviour change."

Chronic Kidney Disease • Nephrology • Renal Disease

Scalable medicines optimisation in CKD: integrated care programme update and impact on prescribing of finerenone and sodium zirconium cyclosilicate (UKKW 2026) - "Sodium zirconium cyclosilicate for treating hyperkalaemia. Published 4 September 2019, updated 24 January 2022."

Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Diabetic Nephropathy • Heart Failure • Hypertension • Metabolic Disorders • Nephrology • Renal Disease • Type 2 Diabetes Mellitus

Efficacy and Tolerability of Sodium Zirconium Cyclosilicate or Patiromer in Managing Hyperkalemia: A Systematic Review and Meta-Analysis. (PubMed, Kidney360) - "Both SZC and patiromer effectively lower serum potassium and provide clinical benefits, with distinct safety considerations. Therapy selection should be guided by treatment goals and the patient's individual risk profile."

Journal • Retrospective data • Constipation • Gastroenterology • Gastrointestinal Disorder

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=100 | Recruiting | Sponsor: AstraZeneca | Trial completion date: Jan 2021 ➔ Jul 2021 | Trial primary completion date: Jan 2021 ➔ Jul 2021

Trial completion date • Trial primary completion date • Pediatrics

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=140 | Recruiting | Sponsor: AstraZeneca | Trial completion date: Dec 2024 ➔ Jun 2026 | Trial primary completion date: Dec 2024 ➔ Jun 2026

Trial completion date • Trial primary completion date • Pediatrics

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=100 | Recruiting | Sponsor: AstraZeneca | Active, not recruiting ➔ Recruiting

Enrollment open • Pediatrics

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=100 | Active, not recruiting | Sponsor: AstraZeneca | Trial completion date: Sep 2021 ➔ Mar 2023 | Trial primary completion date: Sep 2021 ➔ Mar 2023

Trial completion date • Trial primary completion date • Pediatrics

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=140 | Recruiting | Sponsor: AstraZeneca | N=90 ➔ 140 | Trial completion date: Dec 2023 ➔ Dec 2024 | Trial primary completion date: Dec 2023 ➔ Dec 2024

Enrollment change • Trial completion date • Trial primary completion date • Pediatrics

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=100 | Not yet recruiting | Sponsor: AstraZeneca

New P3 trial • Pediatrics

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=100 | Recruiting | Sponsor: AstraZeneca | Not yet recruiting ➔ Recruiting

Enrollment open • Pediatrics

SENEKA: A Clinical Trial to Define the Best Strategy for the Management of Heart Failure in Elderly Patients (clinicaltrials.gov) - P3 | N=94 | Recruiting | Sponsor: Fundación para la Investigación del Hospital Clínico de Valencia | Trial primary completion date: Dec 2025 ➔ Dec 2026

Trial primary completion date • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Nephrology • Renal Disease

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=90 | Recruiting | Sponsor: AstraZeneca | Trial completion date: Mar 2023 ➔ Dec 2023 | Trial primary completion date: Mar 2023 ➔ Dec 2023

Trial completion date • Trial primary completion date • Pediatrics

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=100 | Active, not recruiting | Sponsor: AstraZeneca | Recruiting ➔ Active, not recruiting

Enrollment closed • Pediatrics

SENEKA: a randomized clinical trial to optimize RAASi therapy using sodium zirconium cyclosilicate in elderly patients with heart failure and chronic kidney disease at risk of hyperkalemia (HEART FAILURE 2026) - No abstract available

Clinical • Cardiovascular • Congestive Heart Failure • Heart Failure

Epidemiology of Hyperkalemia Among United States Emergency Departments Patients without End-Stage Renal Disease from 2016-2023. (PubMed, Clin Exp Emerg Med) - "Sodium bicarbonate was given in 38.75%, calcium gluconate or chloride in 32.64%, sodium zirconium cyclosilicate in 24.68%, sodium polystyrene sulfonate in 23.12%, and patiromer in 3.04%. Among adult patients without ESRD, hyperkalemia is an uncommon but important condition, with twothirds requiring admission and two percent experiencing cardiac arrest. Sodium bicarbonate and calcium administration is common, while hemodialysis is rare."

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

PEDZ-K: An Open-label Study to Assess Safety and Efficacy of SZC in Paediatric Patients With Hyperkalaemia (clinicaltrials.gov) - P3 | N=140 | Recruiting | Sponsor: AstraZeneca | Trial completion date: Jun 2026 ➔ Feb 2030 | Trial primary completion date: Jun 2026 ➔ Feb 2030

Trial completion date • Trial primary completion date • Pediatrics

A case of the endoscopic removal of a gastric bezoar made of sodium zirconium cyclosilicate hydrate. (PubMed, Intern Med) - "Impaired gastric motility, acidic gastric environment, and limited hydration are likely contributors. This case highlights the potential for SZC-induced gastric bezoar formation in critically ill patients, and underscores the importance of imaging monitoring, careful gastrointestinal management, and the awareness of this potential complication during SZC therapy."

Journal • Critical care • Endocrine Disorders • Nephrology • Renal Disease