Can we give hemodialysis (HD) patients Lokelma (sodium zirconium cyclosilicate)?

Administration of Lokelma (Sodium Zirconium Cyclosilicate) in Hemodialysis Patients

Yes, Lokelma can be given to hemodialysis patients, but it should only be administered on non-dialysis days with a recommended starting dose of 5 g once daily. 1

Dosing Guidelines for Hemodialysis Patients

• The FDA-approved starting dose for hemodialysis patients is 5 g once daily on non-dialysis days 1
• For patients with serum potassium greater than 6.5 mEq/L, a higher starting dose of 10 g once daily on non-dialysis days can be considered 1
• The maintenance dose range is 5-15 g once daily, administered only on non-dialysis days 1
• Dose adjustments should be based on pre-dialysis serum potassium values after the long inter-dialytic interval 1

Monitoring and Dose Adjustments

• After initiating treatment or adjusting the dose, serum potassium should be assessed after one week 1
• The dose should be decreased or discontinued if:
  • Serum potassium falls below the desired target range based on pre-dialysis values 1
  • The patient develops clinically significant hypokalemia 1
• Patients on hemodialysis may be prone to acute illness that can increase the risk of hypokalemia (e.g., decreased oral intake, diarrhea), requiring dose adjustments 1

Efficacy in Hemodialysis Patients

• Clinical trials have demonstrated that Lokelma effectively lowers serum potassium in hemodialysis patients with persistent pre-dialysis hyperkalemia 1
• In the DIALIZE study, 41% of hemodialysis patients treated with Lokelma maintained pre-dialysis serum potassium between 4.0-5.0 mEq/L compared to only 1% with placebo 1
• Real-world evidence from multicenter clinical audits shows significant reduction in serum potassium levels (average reduction of 0.812 mmol/L) in hemodialysis patients treated with Lokelma 2

Safety Considerations

• Unlike sodium polystyrene sulfonate (SPS), Lokelma has not been associated with intestinal necrosis in clinical trials 3
• The most common adverse effects are hypokalemia and dose-dependent edema 3
• Each 5 g dose contains approximately 400 mg of sodium, which should be considered in patients prone to fluid overload 1
• In clinical trials of hemodialysis patients, there was no difference in interdialytic weight gain between Lokelma and placebo groups 1

Administration Instructions

• Lokelma should be administered as an oral suspension in water 1
• The entire contents of the packet should be emptied into a glass containing approximately 3 tablespoons of water, stirred well, and consumed immediately 1
• Other oral medications should be administered at least 2 hours before or 2 hours after Lokelma 1

Special Considerations

• Avoid use in patients with severe constipation, bowel obstruction, or impaction 1
• Lokelma should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 1
• Lokelma has been shown to be effective regardless of chronic kidney disease stage, including in patients with end-stage renal disease 4

By following these guidelines, Lokelma can be safely and effectively administered to hemodialysis patients to manage hyperkalemia.