Combination therapy using sodium zirconium cyclosilicate and a mineralocorticoid receptor antagonist in patients with heart failure and hyperkalemia
Imamura T, Oshima A, Narang N, Ushijima R, Ueno Y, Ueno H, Kinugawa K. Combination Therapy Using Sodium Zirconium Cyclosilicate and a Mineralocorticoid Receptor Antagonist in Patients with Heart Failure and Hyperkalemia. Intern Med. 2021;60(13):2093-2095. doi: 10.2169/internalmedicine.6704-20. Epub 2021 Jul 1. PMID: 34193775; PMCID: PMC8313903
Hyperkalemia is a challenging comorbidity to manage in patients with heart failure and chronic kidney disease, particularly when administering renin-angiotensin-aldosterone system inhibitors. We encountered an 88-year-old woman with hypertensive heart failure and chronic kidney disease. A mineralocorticoid receptor antagonist was able to be safely administered despite persistent hyperkalemia when sodium zirconium cyclosilicate, a non-absorbed, non-polymer zirconium silicate compound that preferentially exchanges hydrogen and sodium for potassium and ammonium ions in the gastrointestinal tract, was concomitantly administered. Sodium zirconium cyclosilicate might be a promising therapeutic tool to use in order to administer mineralocorticoid receptor antagonist safely in patients with heart failure, chronic kidney disease, and hyperkalemia.