Sodium Zirconium Cyclosilicate for the Acute Management of Hyperkalemia in the Emergency Department

Background: Limited evidence exists examining the use of potassium binders for the acute management of hyperkalemia. Objective: The objective of the study is to evaluate the use of sodium zirconium cyclosilicate (SZC) for the acute management of hyperkalemia. Methods: This retrospective cohort study evaluated patients presenting to the emergency department with an initial potassium >= 5.6 mEq/L and treated with the institutional hyperkalemia order set. Results: Overall, 189 patients were included. There was no significant difference in serum potassium change from baseline to first potassium within 6 hours between the SZC and non-SZC groups (-1.096 +/- 0.71 vs -1.067 mEq/L +/- 0.81, P = 0.798), respectively. No significant difference was seen between the SZC and non-SZC groups for time from initial hyperkalemia to order set medication administration (1.9 +/- 1 vs 2.5 +/- 2.9 hours, P = 0.63), mean hospital length of stay (5.5 +/- 4.5 vs 6.6 days +/- 6.9, P = 0.197), or potassium level at first recheck (5.17 +/- 0.68 vs 5.34 mEq/L +/- 0.76, P = 0.108). Time from the first medication administration to potassium recheck differed by about 1 hour between groups (4.1 +/- 3.1 vs 5.1 hours +/- 3.2, P = 0.035), and patients in the SZC group were less likely to have a potassium >6 mEq/L at the first recheck (10.1% vs 21%, P = 0.047). Conclusion and Relevance: The optimal use of SZC in the acute management remains uncertain based on results from this study with no difference in potassium levels at first recheck.