The potassium binder sodium zirconium cyclosilicate (SZC) may be an effective adjunct therapy to insulin and glucose in the emergency treatment of hyperkalemia, according to new study findings.

In the ENERGIZE phase 2 trial (NCT03337477), 70 emergency department patients with serum potassium of 5.8 mmol/L or higher from 4 countries were randomly assigned to SZC (10 g up to 3 times within 10 hours) or placebo in addition to background insulin and glucose. At 4 hours after the first dose, the primary end point, mean serum potassium declined significantly more in the SZC than placebo group (-0.41 vs -0.27 mmol/L), W. Frank Peacock, MD, of Baylor College of Medicine and Ben Taub General Hospital in Houston, and collaborators reported in Academic Emergency Medicine. The SZC group also showed a small advantage at 2 hours: mean -0.72 vs -0.36, respectively.

Only a fraction of SZC and placebo patients responded to initial treatment only: 6.3% vs 5.6%, respectively. Fewer SZC patients required additional potassium-lowering therapy at 0 to 4 hours: 15.6% vs 30.6%. Another subset of SZC and placebo patients required dialysis within 4 hours: 9.4% vs 13.9%, respectively.

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Comparable proportions of both groups experienced adverse events within 24 hours: 24.1% vs 27.3%, respectively, the team reported. None of the patients experienced hypokalemia, presumably because they also received insulin and glucose.

“Sodium zirconium cyclosilicate in combination with insulin and glucose was well tolerated,” Dr Peacock’s team wrote. “Although the reduction of sK+ at 4 hours was similar in the sodium zirconium cyclosilicate and placebo groups, there were signals indicative of incremental benefit of sodium zirconium cyclosilicate when used in addition to insulin and glucose for the emergency treatment of hyperkalemia.”

Disclosure: This clinical trial was supported by AstraZeneca, the makers of Lokelma® (SZC). Please see the original reference for a full list of authors’ disclosures.

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Peacock WF, Rafique Z, Vishnevskiy K, et al. Emergency potassium normalization treatment including sodium zirconium cyclosilicate: A phase II, randomized, double-blind, placebo-controlled study (ENERGIZE) [published online Mar 9, 2020]. Acad Emerg Med. doi: 10.1111/acem.13954