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Hyperkalemia & Management Solutions

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What is the role of potassium binders in the treatment of patients with hyperkalemia?

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Important Safety Information and Prescribing Information.

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  • Overview

    Defined as high potassium levels in the blood, hyperkalemia can be a life-threatening condition.1 Hyperkalemia is often associated with chronic kidney disease and can be silent or present itself with non-specific symptoms.1,2 However, there are challenges in managing hyperkalemia as a recurrent event.1,3 To help address these challenges, Dr Charles Turck discusses with Dr Anjay Rastogi, nephrologist and head of the CORE Kidney Program at UCLA, the burden of hyperkalemia and how potassium binders can help manage it.3,4

    ©2022 AstraZeneca. All rights reserved. US-57356 Last Updated 2/22
  • Important Safety Information (ISI)

    IMPORTANT SAFETY INFORMATION FOR LOKELMA® (sodium zirconium cyclosilicate)

    WARNINGS AND PRECAUTIONS:

    • Gastrointestinal Adverse Events in Patients with Motility Disorders: Avoid LOKELMA in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders. LOKELMA has not been studied in patients with these conditions and it may be ineffective and may worsen gastrointestinal conditions

    • Edema: Each 5-g dose of LOKELMA contains approximately 400 mg of sodium, but the extent of absorption by the patient is unknown. In clinical trials of LOKELMA in patients who were not on dialysis, edema was observed and was generally mild to moderate in severity and was more commonly seen in patients treated with 15 g once daily. Monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure or renal disease). Advise patients to adjust dietary sodium, if appropriate. Increase the dose of diuretics as needed

    In a clinical trial of LOKELMA in patients on chronic hemodialysis in which most patients were treated with doses of 5 g to 10 g once daily on non-dialysis days, there was no difference in the mean change from baseline in interdialytic weight gain (a measure of fluid retention) between the LOKELMA and placebo groups

    • Hypokalemia in Patients on Hemodialysis: Patients on hemodialysis may be prone to acute illness that can increase the risk of hypokalemia on LOKELMA (eg, illnesses associated with decreased oral intake, diarrhea). Consider adjusting LOKELMA dose based on potassium levels in these settings

    • Diagnostic Tests: LOKELMA has radio-opaque properties and, therefore, may give the appearance typical of an imaging agent during abdominal X-ray procedures

    ADVERSE REACTIONS: The most common adverse reaction in non-dialysis patients with LOKELMA was mild to moderate edema. In placebo-controlled trials up to 28 days, edema was reported in 4.4%, 5.9%, 16.1% of non-dialysis patients treated with 5 g, 10 g, and 15 g of LOKELMA once daily, respectively vs 2.4% of non-dialysis patients receiving placebo.      

    DRUG INTERACTIONS: LOKELMA can transiently increase gastric pH. In general, oral medications with pH-dependent solubility should be administered at least 2 hours before or 2 hours after LOKELMA. Spacing is not needed if it has been determined the concomitant medication does not exhibit pH-dependent solubility.

    INDICATION AND LIMITATION OF USE

    LOKELMA is indicated for the treatment of hyperkalemia in adults.

    LOKELMA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

    PLEASE READ FULL PRESCRIBING INFORMATION.

    References:

    1. Betts K, et al. The cost of hyperkalemia in the United States. Kidney Int Rep. 2018;3(2):385-393.
    2. National Kidney Fund. Clinical Update on Hyperkalemia: A Chronic Risk for CKD Patients and a Potential Barrier to Recommended CKD Treatment. https://www.kidney.org/sites/default/files/02-10-6785_HBE_Hyperkalemia_Bulletin.pdf
    3. Epstein M, et al. Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors. Am J Manag Care. 2015;21(11 suppl):S212-S220.
    4. Palmer BF. Potassium binders for hyperkalemia in chronic kidney disease—diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis. Mayo Clin Proc. 2020;95(2):339-354. 
Schedule28 May 2022
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