Summary

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• This summary is based on the review of seven systematic review(s)/meta-analysis(es). ^[1-7]
• Sodium zirconium cyclosilicate (SZC) significantly reduced serum potassium levels compared to placebo (mean difference (MD): -0.42 mmol/L; 95% confidence interval (CI): -0.63 to -0.20, p = 0.0001) and achieved normokalemia more effectively than placebo (relative risk (RR): 3.48, 95% CI: 1.49 to 8.11, p = 0.004). Patiromer also reduced serum potassium levels (MD: -0.62 mEq/L; 95% CI: -0.97, -0.27).
• Novel potassium binders (NPB), including SZC, improved the renin–angiotensin–aldosterone system (RAAS) inhibitor therapy optimization by 14% (95% CI: 4-26%) and reduced hyperkalemia episodes by 29% (95% CI: 55-92%) in heart failure patients.
• SZC was associated with a higher incidence of edema (OR: 6.77; 95% CI: 1.03-44.25), while patiromer demonstrated fewer side effects like edema and had a lower rate of hyperkalemia compared to standard care.
• Newer agents like SZC and patiromer had a better safety profile than older agents like sodium polystyrene sulfonate (SPS), which was linked to more gastrointestinal symptoms such as nausea, diarrhea, and constipation.
• Patients with chronic kidney disease (CKD) stages 1 to 5 and those on hemodialysis, as well as heart failure (HF) patients using RAAS inhibitors, benefited from novel potassium binders (NPBs) like SZC and patiromer. Both agents effectively reduced serum potassium levels and allowed for better optimization of RAAS inhibitor therapy, with SZC associated with higher rates of edema, particularly in HF patients.