Use of Sodium Zirconium Cyclosilicate for the Management of Hyperkalemia in Dogs and Cats

Abstract: Background: Hyperkalemia is a life-threatening emergency requiring prompt correction. Acute kidney injury and chronic kidney disease patients may experience hyperkalemia. Therapies that correct hyperkalemia through kaluresis may be less effective in these patients. Sodium zirconium cyclosilicate (SZC) is approved for managing hyperkalemia in humans, by exchanging potassium for sodium across the gut capillaries.
Hypothesis/Objectives: To evaluate the efficacy of SZC in dogs and cats with naturally occurring hyperkalemia.
Animals: Dogs and cats with hyperkalemic kidney disease
Methods: Retrospective medical record review identified patients who were administered SZC and had at least one recheck assessment of hyperkalemia. Patients who received other therapies to mitigate hyperkalemia were excluded from analysis.
Results: Nine dogs and 2 cats were eligible for enrollment. Two dogs were administered SZC to control interdialytic hyperkalemia. The median starting serum potassium concentration was 7.0 mmol/L (range 4.6-6.6 mmol/L). The median dose of SZC was 0.11g/kg (range 0.08-0.19g/kg). Most received this dose PO q8 hours for the first 24 hours, then q24 hours thereafter. Median time to recheck potassium as 20 hours (range 1-288 hours). The serum potassium decreased in 5/7 (71.4%) dialysis independent patients. Median change in potassium was -1.31mmol/L (range -2.1 – 1.8mmol/L). Dose of SZC in the two patients who experienced progressive hyperkalemia was 0.08g/kg, where all other patients received >0.11g/kg. The two dialysis patients had resolution of their interdialytic hyperkalemia following initiation of SZC.
Conclusions and clinical importance: SZC is an effective therapy for the management of hyperkalemia. Further study is needed to optimize effective dose.