Profesor Invitado: Dr. Mauricio Arvizu Hernández
Especialista en Nefrología

Objetivo de Aprendizaje:

• Identificar los perfiles de pacientes con hipercalemia que pueden beneficiarse del tratamiento con ciclosilicato de sodio y zirconio.

• Reconocer el impacto de la hipercalemia en pacientes con ERC bajo tratamiento con iSRAA, particularmente en la continuidad terapéutica.

• Comprender el papel del ciclosilicato de sodio y zirconio como estrategia para el control del potasio y la optimización del manejo cardiorrenal.

Referencias:

1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314.​
2. Secretaría de Salud. Protocolo Nacional de Atención Médica (PRONAM) de Hipertensión Arterial Sistémica, 1a edición. https://pronamsalud.csg.gob.mx/pronam-hipertension-arterial-sistemica.pdf ​
3. Secretaría de Salud. Protocolo Nacional de Atención Médica (PRONAM) de Diabetes tipo 2 y síndrome metabólico. https://pronamsalud.csg.gob.mx/pronam-diabetes-tipo2-sindrome-metabolico.pdf ​
4. Kovesdy CP. Management of hyperkalaemia in chronic kidney disease. Nat Rev Nephrol. 2014 Nov;10(11):653-62. ​
5. Vardeny O, et al. Incidence, predictors, and outcomes related to hypo- and hyperkalemia in patients with severe heart failure treated with a mineralocorticoid receptor antagonist. Circ Heart Fail. 2014 Jul;7(4):573-9. ​
6. Xu H, et al. Prevalence of hyperkalemia in DOPPS: a real-world, international cohort of hemodialysis patients. Poster presented at: European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) 54th Annual Congress; 2017 Jun 3–6; Madrid, Spain. DOI: 10.3252/pso.eu.54ERA.2017.​
7. Bem D, et al. The effect of hyperkalemia and long inter-dialytic interval on morbidity and mortality in patients receiving hemodialysis: a systematic review. Ren Fail. 2021 Dec;43(1):241-254. ​
8. Nilsson E, et al. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J Cardiol. 2017 Oct 15:245:277-284.​
9. Chomicki J, et al. Evaluation of the incidence of hyperkalemia in patients prescribed spironolactone for the treatment of resistant hypertension. J Am Soc Hypertens. 2014;8(4S):e30. Abs. P-10.​
10. Khosla N, et al. Predictors of hyperkalemia risk following hypertension control with aldosterone blockade. Am J Nephrol. 2009;30(5):418-24.
11. Thomsen RW, et al. Elevated potassium levels in patients with chronic kidney disease: occurrence, risk factors and clinical outcomes-a Danish population-based cohort study. Nephrol Dial Transplant. 2018 Sep 1;33(9):1610-1620. ​
12. Dunn JD, et al. The burden of hyperkalemia in patients with cardiovascular and renal disease. Am J Manag Care. 2015;21(15 Suppl):bs307–s315. ​
13. Rowan CG, et al. Poster #296 presented at National Kidney Foundation Spring clinical Meetings, Austin, USA, April 11-15, 2023​
14. Epstein M, et al. Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors. Am J Manag Care. 2015 Sep;21(11 Suppl):S212-20.​
15. Thomsen RW, et al. Elevated Potassium Levels in Patients With Congestive Heart Failure: Occurrence, Risk Factors, and Clinical Outcomes: A Danish Population-Based Cohort Study. J Am Heart Assoc. 2018 May 22;7(11):e008912.​
16. McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726.​
17. Pecoits-Filho R, et al. Optimization of Renin-Angiotensin-Aldosterone Inhibitor Therapies for Evidence-Based Indications: a Call to Action From the Cardio-Kidney Community. Kidney Int Rep. 2025 Jun 9;10(7):2081-2087.​
18. Mancia G, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023 Dec 1;41(12):1874-2071.​
19. House AA, et al. Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019 Jun;95(6):1304-1317.​
20. Packham DK, et al. Sodium zirconium cyclosilicate in hyperkalemia. Article and protocol. N Engl J Med. 2015 Jan 15;372(3):222-31.
21. Kosiborod M, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA. 2014 Dec 3;312(21):2223-33.​
22. Roger SD, et al. Efficacy and Safety of Sodium Zirconium Cyclosilicate for Treatment of Hyperkalemia: An 11-Month Open-Label Extension of HARMONIZE. Supplementary Materials. Am J Nephrol. 2019;50:473-480. ​
23. Fishbane S, et al. A Phase 3b, Randomized, Double-Blind, Placebo-Controlled Study of Sodium Zirconium Cyclosilicate for Reducing the Incidence of Predialysis Hyperkalemia. J Am Soc Nephrol. 2019 Sep;30(9):1723-1733.​
24. Información amplia para prescribir LOKELMA®