Summary

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• Lokelma (sodium zirconium cyclosilicate) is indicated for the treatment of hyperkalemia in adults.
• This summary is based on the review of nine systematic review(s)/meta-analysis(es). ^[1-9]
• New potassium binders (NPBs) were associated with improved RAASi therapy optimization, with a relative risk (RR) of 1.13 (95% CI: 1.02-1.25, P=0.02) and reduced instances of patients receiving suboptimal MRA doses (RR: 0.72, 95% CI: 0.57-0.90, P=0.004). Potassium binders also increased RAASi use with an RR of 1.14 (95% CI: 1.02-1.28, P=0.021).
• NPBs significantly reduced the risk of hyperkalemia, with RR values ranging from 0.42 (95% CI: 0.24-0.72, P=0.002) to 0.66 (95% CI: 0.52-0.84, P<0.001), and decreased hyperkalemia events by 29% (95% CI: 55-92%).
• Sodium zirconium cyclosilicate (SZC) effectively reduced serum potassium levels (mean reduction: -0.42 mmol/L, 95% CI: -0.63 to -0.20, P=0.0001) and significantly increased the proportion of patients achieving normokalemia (RR 3.48, 95% CI 1.49-8.11, P=0.004).
• New potassium binders (NPBs) were generally well-tolerated but were associated with an increased risk of hypokalemia (RR: 1.57, 95% CI: 1.12-2.21, P=0.009) and an increased risk of edema with SZC (RR 4.30, 95% CI 1.17-15.84, P=0.03).
• Older potassium binders, particularly sodium polystyrene sulfonate (SPS), were associated with more severe gastrointestinal adverse effects, such as colonic necrosis, hypomagnesemia, and hypernatremia, compared to newer binders like patiromer and SZC, which may cause fewer gastrointestinal side effects.
• Potassium binders were effective in optimizing RAASi therapy and reducing hyperkalemia in specific subgroups, including heart failure patients, chronic kidney disease patients, patients using RAAS inhibitors, and those with diabetes, with noted risks of hypokalemia, edema with SZC, and gastrointestinal adverse effects more prominent with older binders.