{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T16:28:35Z","timestamp":1780676915844,"version":"3.54.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T00:00:00Z","timestamp":1628985600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Patients often receive suboptimal dosing of renin\u2013angiotensin\u2013aldosterone system inhibitor (RAASi) therapy over concerns of hyperkalaemia. However, studies have shown associations between suboptimal dosing or interruptions to therapy and adverse clinical events. Therefore, effective treatments for hyperkalaemia that can enable optimal RAASi therapy are needed. This case series examines eight patients whose commencement on the novel potassium binder sodium zirconium cyclosilicate (SZC) allowed for the initiation and\/or up-titration of RAASi therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>Eight patients aged 64\u201387\u2009years with heart failure (HF) with reduced ejection fraction all developed hyperkalaemia (serum potassium (sK+) &amp;gt;5.0\u2009mmol\/L) while receiving RAASi therapy. Following initiation of SZC, all patients experienced eventual stabilization of sK+ levels. All patients were able to initiate, restart, or up-titrate RAASi therapy with five patients achieving optimal medical therapy. Left ventricular ejection fraction improved in four patients, two patients are now re-classified as New York Heart Association Class I, and an additional patient had improved exercise tolerance. Follow-up for Patient 8 is still ongoing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>These real-world cases demonstrate that use of SZC to manage hyperkalaemia in patients with HF is feasible and allows optimization of RAASi therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab281","type":"journal-article","created":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T18:31:08Z","timestamp":1629052268000},"source":"Crossref","is-referenced-by-count":6,"title":["Use of sodium zirconium cyclosilicate for up-titration of renin\u2013angiotensin\u2013aldosterone system inhibitor therapy in patients with heart failure: a case series"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0840-9292","authenticated-orcid":false,"given":"Rhys","family":"Williams","sequence":"first","affiliation":[{"name":"Cardiology Department, Princess of Wales Hospital, Coity Road, Bridgend, Wales CF31 1RQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6511-3039","authenticated-orcid":false,"given":"Alexander","family":"James","sequence":"additional","affiliation":[{"name":"Cardiology Department, Princess of Wales Hospital, Coity Road, Bridgend, Wales CF31 1RQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3558-9540","authenticated-orcid":false,"given":"Moira","family":"Ashton","sequence":"additional","affiliation":[{"name":"Formerly of Cardiology Department, Princess of Wales Hospital, Coity Road, Bridgend, Wales CF31 1RQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sian","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Cardiology Department, Princess of Wales Hospital, Coity Road, Bridgend, Wales CF31 1RQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4701-7227","authenticated-orcid":false,"given":"Aaron","family":"Wong","sequence":"additional","affiliation":[{"name":"Cardiology Department, Princess of Wales Hospital, Coity Road, Bridgend, Wales CF31 1RQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,15]]},"reference":[{"key":"2021081518310414200_ytab281-B1","first-page":"510","article-title":"Acute decompensated heart failure: contemporary medical management","volume":"36","author":"Joseph","year":"2009","journal-title":"Tex Heart Inst J"},{"key":"2021081518310414200_ytab281-B2","doi-asserted-by":"crossref","first-page":"3182","DOI":"10.3390\/ijms20133182","article-title":"Renin activity in heart failure with reduced systolic function-new insights","volume":"20","author":"Sullivan","year":"2019","journal-title":"Int J Mol Sci"},{"key":"2021081518310414200_ytab281-B3","doi-asserted-by":"crossref","first-page":"e003529","DOI":"10.1161\/CIRCHEARTFAILURE.116.003529","article-title":"Thirty years of evidence on the efficacy of drug treatments for chronic heart failure with reduced ejection fraction: a network meta-analysis","volume":"10","author":"Burnett","year":"2017","journal-title":"Circ Heart Fail"},{"key":"2021081518310414200_ytab281-B4","first-page":"S212","article-title":"Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors","volume":"21","author":"Epstein","year":"2015","journal-title":"Am J Manag Care"},{"key":"2021081518310414200_ytab281-B5","doi-asserted-by":"crossref","first-page":"e012655","DOI":"10.1161\/JAHA.119.012655","article-title":"Real-world associations of renin-angiotensin-aldosterone system inhibitor dose, hyperkalemia, and adverse clinical outcomes in a cohort of patients with new-onset chronic kidney disease or heart failure in the United Kingdom","volume":"8","author":"Linde","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2021081518310414200_ytab281-B6","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1159\/000479802","article-title":"Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and\/or diabetes","volume":"46","author":"Collins","year":"2017","journal-title":"Am J Nephrol"},{"key":"2021081518310414200_ytab281-B7","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.3109\/0886022X.2012.717478","article-title":"Major barriers against renin-angiotensin-aldosterone system blocker use in chronic kidney disease stages 3-5 in clinical practice: a safety concern?","volume":"34","author":"Yildirim","year":"2012","journal-title":"Ren Fail"},{"key":"2021081518310414200_ytab281-B8","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1002\/ejhf.1793","article-title":"Unravelling the interplay between hyperkalaemia, renin-angiotensin-aldosterone inhibitor use and clinical outcomes. 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