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LOKELMA® (sodium zirconium cyclosilicate) is indicated for the treatment of hyperkalaemia in adult patients.
Hyperkalaemia is a common electrolyte disorder characterised by high potassium levels in the blood.3 It is defined as serum or plasma potassium >5 mmol/L (for potassium 1 mmol/L = 1 mEq/L).2
Serum potassium levels, mmol/L
Adapted from Di Lullo et al. (2019)3
Severe hyperkalaemia (plasma potassium >6 mmol/L) may be responsible for cardiac arrythmias leading to cardiac arrest and death, with a resulting mortality rate of up to 30%.2 However, for many patients hyperkalaemia symptoms are often not present.4
Life-threatening hyperkalaemia requires immediate treatment.2,5
Acute Hyperkalaemia | Persistent Hyperkalaemia |
| Occurrence Single event7 | Occurrence Periodic or recurrent events7 |
| Ongoing management No6 | Ongoing management Yes6 |
| Pathology Abnormal net release of potassium from cells due to trauma, metabolic acidosis, haemolytic states6 | Pathology Impaired potassium excretion6 |
Treatment goals
| Treatment goals
|
Adapted from National Kidney Foundation (2016), National Kidney Foundation (2017) and Alfonzo et al. (2020)5–7
There are various reasons why a patient may present as hyperkalaemic, including:
Particular drugs can cause high potassium levels including those used to manage CKD and HF, amongst other conditions.12
Mechanism | Drug | |
| Defective aldosterone signalling | Impaired renin production | β-blockers and NSAIDs |
| Impaired renin-angiotensin signalling | Aliskiren, ACEis and ARBs | |
| Impaired aldosterone synthesis | Heparin and ketoconazole | |
| MR blockade | Spironolactone and eplerenone | |
| Defective distal electrogenic sodium reabsorption | ENaC blockade | Amiloride, triamterene, trimethoprim, pentamidine and lithium |
| NCC activation | CNIs | |
| Cellular potassium translocation | Changes in transcellular transporters | α-Agonists, β-blockers, digoxin, succinylcholine,* isoflurane, minoxidil and somatostatin |
| Solvent drag in osmotic shifts | Mannitol | |
| Exogenous potassium load | High potassium content | Penicillins (intravenous) |
Adapted from Hunter and Bailey (2019).12
*Succinylcholine is not licensed for use in the UK.
The incidence of hyperkalaemia in the general population is 2–3%, but is higher in certain patient subgroups:13
Patients with HF and CKD have a greater risk of death from hyperkalaemia than those without these comorbidities, and those with multiple comorbidities are at even higher risk.18
Adapted from Collins et al. (2017)18
*Significant vs. control group;19 †Control group comprised of individuals without known HF, CKD, diabetes, CVD, or hypertension.
For patients with CKD or HF, hospitalisation associated with hyperkalaemia is:
Population-based cohort studies linking individual data from hospital, prescription, and laboratory databases in patients from the Danish National Patient Registry in Northern Denmark (population 1.8 million) during 2000–2012.20,21 Patients with a first-time diagnosis of CKD (N=157,766) and HF were identified (N=31,649).20,21 Hyperkalaemia defined as potassium >5.0 mmol/L.20,21
In the UK, there are high hyperkalaemia-specific costs associated with hospitalisations for patients with particular comorbidities, including:22
From a UK cohort of 498,196 patients aged ≥18 years hospitalised with hyperkalaemia between January 2003 and June 2018 and a record of relevant cardiovascular and renal comorbidities, 36.9% had hypertension, 33.8% diabetes, 35.1% CKD, 11.0% HF, and 0.6% were in receipt of dialysis.22
ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin receptor blocker; CI=confidence interval; CKD=chronic kidney disease; CNI=calcineurin inhibitor; CV=cardiovascular; CVD=cardiovascular disease; ENaC=epithelial sodium channel; HF=heart failure; HR=hazard ratio; MR=mineralocorticoid receptor; MRA=mineralocorticoid receptor antagonist; NCC=sodium chloride co-transporter; NSAIDs=non-steroidal anti-inflammatory drugs; NYHA=New York Heart Association; RAAS=renin-angiotensin-aldosterone system; RAASi=renin-angiotensin-aldosterone system inhibitor.
GB-63501 | DOP: February 2025
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