Sodium zirconium cyclosilicate hydrate reduces medical expenses compared with hemodialysis in patients with acute hyperkalemia

Background: Sodium zirconium cyclosilicate (SZC) has recently emerged as a therapeutic option for the management of acute hyperkalemia. Nevertheless, the relative effectiveness, safety, and financial considerations of SZC therapy versus conventional hemodialysis therapy remain uncertain. Methods: In this retrospective study, we embarked upon a comparative analysis encompassing the financial aspects, safety profiles, and efficacy metrics associated with SZC therapy and hemodialysis in patients grappling with acute hyperkalemia. No patients had systemic congestion or uremia. Results: A total of 21 patients (median 81 years old, 14 men) were included; 14 received SZC therapy and seven underwent hemodialysis. Acute hyperkalemia improved immediately within several days without any procedure-related adverse events, regardless of therapeutic interventions (p < 0.05 for both). Total medical expenses were significantly lower in the SZC group than in the hemodialysis group (55,596 [43,652, 69,761] vs. 419,768 [354,270, 514,700] Japanese yen, p < 0.001). Conclusions: In the realm of acute hyperkalemia management, SZC therapy emerges as an economically judicious alternative, while upholding parity in terms of safety and effectiveness when compared with the conventional hemodialysis paradigm—unless complicated by systemic congestion or uremia. The pressing task at hand revolves around the discernment of the optimal patient demographic for SZC therapy within the ambit of acute hyperkalemia.