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SZC vs Patiromer Mechanism — ESENeph MCQ

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ModerateElectrolyte DisordersSZC vs Patiromer MechanismESENeph

A 58-year-old woman with CKD G4 on Ramipril and Dapagliflozin has a potassium of 5.3 mmol/L. She eats a healthy diet rich in fruits and vegetables. She asks about Sodium Zirconium Cyclosilicate (SZC) versus Patiromer. What is the key difference in their mechanism?

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Correct answer: E — SZC is an inorganic crystal that selectively captures potassium throughout the GI tract in exchange for hydrogen and sodium; Patiromer is an organic polymer that binds potassium in the colon in exchange for calcium

SZC (Lokelma) is a non-absorbed inorganic zirconium silicate crystal with 9x selectivity for potassium over other cations. It acts throughout the entire GI tract and exchanges K+ for H+ and Na+. Onset is within 1 hour (suitable for acute and chronic use). Patiromer (Veltassa) is a non-absorbed organic polymer that binds K+ in the distal colon in exchange for Ca2+. Onset is slower (7-48 hours, suitable for chronic use only). Both enable continuation of renoprotective RAAS-modulating drugs. Side effects: SZC may cause oedema (sodium exchange); Patiromer may cause GI disturbance and hypomagnesaemia.

Reference: KDIGO 2024 – CKD; BNF 2024 – SZC and Patiromer