Session Name: Kidney: Cardiovascular and Metabolic Complications
Session Date & Time: None. Available on demand.
*Purpose: Hyperkalemia is a common problem experienced by kidney transplant recipients (KTR)s. New strategies to treat hyperkalemia are now available. KTRs often require medications that raise serum potassium (K). Sodium zirconium cyclosilicate (ZS-9) lowers serum K levels via exchanging sodium and hydrogen for potassium in the gastrointestinal tract. Its safety and efficacy in KTRs is unknown.
*Methods: This was a single-center retrospective analysis of KTRs with hyperkalemia (serum K >5.1mEq) treated with sodium zirconium cyclosilicate from 12/2019 – 10/2020. Treatment was determined by electronic medical record review of the medication administration record and/or documented use. Primary outcomes were need for renal replacement therapy and change in serum K at ~ 48 hours (mmol/L). Secondary outcomes included use of potassium raising medications, mean change in tacrolimus level (ng/dL), significant hypokalemia (serum K <3.0mmol/L), major gastrointestinal adverse outcomes (bleed, perforation, ischemic colitis, post-operative ileus) and hypersensitivity reactions.
*Results: 27 KTRs with hyperkalemia were treated with ZS-9 from 12/2019 – 10/2020. Mean age at transplant was 52 years. Median time to use since transplant was 0.75 years. Most patients were white (17, 63%) men (23, 85%). Diabetes mellitus (11, 41%) and glomerulonephritis (10, 37%) were the leading causes of end stage kidney disease. 5 (19%) patients were living donor recipients. Basiliximab (18, 67%) was the primary induction agent used. Most patients (22, 81%) were on standard triple maintenance immunosuppression. Mean baseline serum creatinine was 3.71 ± 2.84 mg/dL. 16 (59%) of the patients were inpatient. 6 (23%) had delayed graft function. 5 (19%) had slow graft function. Mean total ZS-9 used was 30 gm; mean doses utilized was 3. 9 patients were treated with ZS-9 within 30 days of transplant. The remaining 18 received ZS-9 thereafter. Primary outcomes wise, 6 patients (22%) required hemodialysis. 3 (50%) underwent hemodialysis for hyperkalemia. The mean decrease in K at ~48 hours was 0.8 ± 0.5 mmol/L. In steady state patients (n = 5), tacrolimus levels remained stable with the mean change of 1.3 ± 0.7 ng/mL. Patients were also able to remain on potassium raising medications e.g. prophylactic (n=4) and treatment (n =1 for Pneumocystis pneumonia, 1 for Nocardiosis) dosed trimethoprim-sulfamethoxazole, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/mineralocorticoid receptor antagonists (n=4), treatment dosed heparin (n=2), and azoles (n=2). Safety wise, no major adverse outcomes were observed. Edema is a concern but could not be assessed precisely due to multiple, dynamic factors driving fluid status in this population.
*Conclusions: Sodium zirconium cyclosilicate appears to be an effective, safe medication in KTRs. More studies are needed to characterize its use in the kidney transplant population.
To cite this abstract in AMA style:Swanson KJ, Aziz F, Parajuli S, Mohamed M, Mandelbrot DA, Djamali A, Garg N. Sodium Zirconium Cyclosilicate Use in Kidney Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/sodium-zirconium-cyclosilicate-use-in-kidney-transplant-recipients/. Accessed June 11, 2021.
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