Abstract
Managing ACUTE Hyperkalaemia in Frail INDIVIDUALS USING A MODERN POTASSIUM BINDER SODIUM ZIRCONIUM CYCLOSILICATE (LOKELMA®)
Background
Hyperkalemia is a common life-threatening electrolyte abnormality present in acutely admitted frail patient, often in context of Acute Kidney Injury (AKI), background of Chronic Kidney Disease (CKD) and a variety of medications such as renin-angiotensin-aldosterone system (RAAS) inhibitors.
NICE TA 599 guidance recommends the use of a modern K+ binder such as Sodium Zirconium Cyclosilicate (SZC) in the acute setting alongside standard of care. This case series was carried out with a view to gain clinical experience specifically in acutely unwell frail older individuals presenting to a District General Hospital in UK.
Methods
Eight patients presenting to ED at Medway NHS Foundation Trust over 3-week period between 7th June -11th July 2023 with Hyperkalemia were treated with SZC, data was collected retrospectively.
Results (N=8)
· Sex: Male:4, Female 4
· Age range: Mean age 86 years (range: 69-105 years)
· Clinical Frailty Score: ≥ 6 in all cases
· Average serum K+ on admission: 5.75 mmol/l (range: 5.6 – 6.3 mmol/l)
· Comorbidities: CKD: 6 / 8, T2DM 5/8, Hypertension 5/8, CCF 4/8
AKI present in 6/8, Sepsis present in 4/8
Management: SZC 10 g tds was managed to correct hyperkalemia alongside established standard of care measures for acute hyperkalemia management. Fluid resuscitation, antibiotics and discontinuation of culprit medications was carried out where indicated.
Effectiveness of SZC
· Normokalaemia was achieved in 4/ 8 of cases within 24 hours of admission
· In the remaining 4 patients, 3 achieved normokalemia within 48 hours and in 1 patient serum K+ was normalised in 72 hours after commencing treatment with SZC
Conclusions
• Clinicians gained familiarity with prescribing SZC, in managing acute hyperkalaemia in frail older patients
• Demonstrated effectiveness of SZC specifically in frail elderly population
• Change in local guidelines for acute hyperkalaemia management: SZC (Lokelma®) is now available in ED, on all acute medical wards