Longer maintenance therapy with the potassium binder sodium zirconium cyclosilicate (SZC) may reduce hyperkalemia-related hospitalization rates, new research suggests.

In the RECOGNIZE I retrospective study, 748 patients (64.9%) received short-term SZC therapy of 90 days or less and 405 patients (35.1%) received  SZC therapy for more than 90 days (the long-term group). The daily dose was 5 g, 10 g, and 15 g for 23.1%, 69.3%, and 7.6% of patients, respectively.

The rate of hyperkalemia-related inpatient hospitalizations was significantly lower with long-term vs short-term SZC therapy: 10.1% vs 15.1%, Abiy Agirob, PhD, of AstraZeneca in Wilmington, Delaware, and colleagues reported in Expert Review of Pharmacoeconomics & Outcomes Research. The rates of all-cause hospitalization (22.5% vs 29.3%) and all-cause emergency department visits (20.0% vs 26.3%) were also significantly lower with long-term use of the potassium binder. Some of these differences may be attributable to baseline differences, such as more frequent contact with health care providers, the investigators noted in the study limitations. They had no information on hyperkalemia severity.

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Of the 1153 patients in the cohort, 58.5% had stage 3-5 chronic kidney disease (CKD), including end-stage kidney disease, and 57.1% were receiving renin-angiotensin-aldosterone-system inhibitors. Patients with stage 3 CKD had significant 1.9-fold increased odds of remaining on SZC therapy for longer than 90 days compared with those without CKD, the investigators reported.

“These data suggest that long-term maintenance SZC therapy may be associated with a reduced risk of hyperkalemia-related hospitalization compared with short-term therapy,” Dr Agirob’s team wrote. “Whether this reduction leads to reduced hyperkalemia-related healthcare costs should be investigated in future studies.”

Disclosure: This research was supported by AstraZeneca. Please see the original reference for a full list of disclosures.


Pollack CV Jr, Agiro A, Mu F, et al. Impact on hospitalizations of long-term versus short-term therapy with sodium zirconium cyclosilicate during routine outpatient care of patients with hyperkalemia: the recognize I study. Expert Rev Pharmacoecon Outcomes Res. 2022 Dec 28:1-10. doi:10.1080/14737167.2023.2161514