{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T03:38:05Z","timestamp":1771472285120,"version":"3.50.1"},"reference-count":11,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,10]],"date-time":"2022-09-10T00:00:00Z","timestamp":1662768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Sodium zirconium cyclosilicate (SZC), a newly introduced potassium binder, is indicated for treating hyperkalemia. SZC-incorporated up-titration of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists has been recommended for those with systolic heart failure, whereas SZC is often terminated following the improvement of hyperkalemia in real-world practice. We aimed to investigate the impact of SZC cessation on the recurrence of hyperkalemia. Methods: Patients with systolic heart failure, in whom SZC was discontinued following improvement in hyperkalemia, were studied and compared to those who had continued SZC. All patients were followed for one year or until August 2022. The recurrent rates of hyperkalemia were compared between the two groups. Results: A total of 30 patients (median age 83 years, 53% men, median left ventricular ejection fraction 42%) were included. The one-year cumulative incidence of recurrent hyperkalemia was 93% in the group who discontinued SZC versus 22% in those who continued SZC (p = 0.032). In the group where SZC was withdrawn, doses of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists were less up-titrated, echocardiographic evidence of reverse remodeling occurred less, and readmission due to worsening heart failure tended to be higher compared to those who remained on SZC therapy. Conclusions: SZC cessation was associated with recurrent hyperkalemia and suboptimal medical therapy optimization compared to continuation of SZC therapy.<\/jats:p>","DOI":"10.3390\/jcm11185330","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T01:44:03Z","timestamp":1663033443000},"page":"5330","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of Sodium Zirconium Cyclosilicate Therapy Cessation in Patients with Systolic Heart Failure"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7294-7637","authenticated-orcid":false,"given":"Teruhiko","family":"Imamura","sequence":"first","affiliation":[{"name":"Second Department of Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikhil","family":"Narang","sequence":"additional","affiliation":[{"name":"Advocate Christ Medical Center, Oak Lawn, IL 60453, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichiro","family":"Kinugawa","sequence":"additional","affiliation":[{"name":"Second Department of Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Stavros, F., Yang, A., Leon, A., Nuttall, M., and Rasmussen, H.S. (2014). Characterization of structure and function of ZS-9, a K+ selective ion trap. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0114686"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1016\/j.ekir.2019.05.018","article-title":"Hyperkalemia in Real-World Patients under Continuous Medical Care in Japan","volume":"4","author":"Kashihara","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e13941","DOI":"10.1111\/ijcp.13941","article-title":"Risk factors associated with the incidence and recurrence of hyperkalaemia in patients with cardiorenal conditions","volume":"75","author":"Tafesse","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1093\/ckj\/sfab225","article-title":"Serum potassium variability as a predictor of clinical outcomes in patients with cardiorenal disease or diabetes: A retrospective UK database study","volume":"15","author":"James","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jchf.2018.10.003","article-title":"Incidence, Predictors, and Outcome Associations of Dyskalemia in Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction","volume":"7","author":"Savarese","year":"2019","journal-title":"JACC Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1161\/CIRCHEARTFAILURE.114.001104","article-title":"Randomized Aldactone Evaluation Study I. Incidence, predictors, and outcomes related to hypo- and hyperkalemia in patients with severe heart failure treated with a mineralocorticoid receptor antagonist","volume":"7","author":"Vardeny","year":"2014","journal-title":"Circ. Heart Fail."},{"key":"ref_8","first-page":"54","article-title":"Efficacy and safety of sodium zirconium cyclosilicate for hyperkalaemia: The randomized, placebo-controlled HARMONIZE-Global study","volume":"7","author":"Zannad","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s10157-020-01972-y","article-title":"A phase 3 multicenter open-label maintenance study to investigate the long-term safety of sodium zirconium cyclosilicate in Japanese subjects with hyperkalemia","volume":"25","author":"Kashihara","year":"2021","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_10","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":"ref_11","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."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/18\/5330\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:29:17Z","timestamp":1760142557000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/18\/5330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,10]]},"references-count":11,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcm11185330"],"URL":"https:\/\/doi.org\/10.3390\/jcm11185330","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,10]]}}}