Real-World Utilization of Sodium Zirconium Cyclosilicate in Hyperkalemia Management in Italy

OBJECTIVES: Hyperkalemia (HK) is common in patients with chronic kidney disease (CKD) and heart failure (HF), especially those on renin-angiotensin-aldosterone system inhibitors (RAASi). Fear of HK often leads to discontinuation of RAASi due to the risk of cardiac arrhythmias and mortality. New treatments, such as sodium zirconium cyclosilicate (SZC), have been approved for managing HK and is reimbursed in Italy since 2021. This study aimed to collect real-world data on the use of SZC for HK treatment and associated healthcare resource utilization in Italian clinical practice.

METHODS: Using administrative databases of Italian healthcare entities covering about 6,000,000 residents, patients with at least one prescription of SZC from January 2022 to June 2023 were identified. Patients prescribed other K-binders or resins after the index date were excluded.

RESULTS: A total of 355 adult patients prescribed with SZC were included (mean age 70.4 years, 64.2% males). At index date, 23.4% had HF, 43.4% diabetes mellitus, 57.5% hypertension and 69.3% CKD (of which 47.6% on dialysis). Most SZC patients (83.1%) were treated short-term (≤90 days) while the remaining 16.9% were treated long-term (>90 days). Multivariate regression showed that dialysis predicted short-term treatment. During the first 6 months of follow-up, the total mean healthcare cost per SZC patient was €7,943 for short-term treated patients (cost of dialysis €3,452) and €6,647 for long-term treated patients (cost of dialysis €1,130). A subgroup of 256 patients received RAASi at baseline or during follow-up: RAASi discontinuation was less prevalent in patients treated with SZC long-term than short-term (41.2% vs 56.6%). The mean cost was €6,908 for those who discontinued RAASi and €5,882 for those who did not.

CONCLUSIONS: This study provides insights into the Italian real-world use of SZC. RAASi discontinuation and healthcare costs were lower with long-term SZC treatment.