AF Anticoagulation Dialysis Uncertainty — ESENeph MCQ

Correct answer: B — Offer sodium zirconium cyclosilicate to support RAAS-inhibitor use

The best answer is “Offer sodium zirconium cyclosilicate to support RAAS-inhibitor use”. TA1148 supports sodium zirconium cyclosilicate for persistent hyperkalaemia in non-dialysis CKD G3b-G5 or heart failure when confirmed potassium is at least 5.5 mmol/L and hyperkalaemia prevents optimised RAAS inhibition. “Start sodium zirconium cyclosilicate because one unconfirmed potassium was 5.1 mmol/L” is less appropriate because the persistent indication requires confirmed potassium of at least 5.5 mmol/L “Use sodium zirconium cyclosilicate after maintenance dialysis begins” is less appropriate because the persistent-hyperkalaemia recommendation excludes people on dialysis “Permanently stop every RAAS inhibitor before considering potassium-lowering treatment” is less appropriate because the appraisal specifically addresses hyperkalaemia that prevents an optimised RAAS-inhibitor dose “Use sodium zirconium cyclosilicate as the sole emergency treatment for an unstable arrhythmia” is less appropriate because life-threatening hyperkalaemia requires standard emergency care, with the binder used alongside it when selected

Reference: NICE TA1148: sodium zirconium cyclosilicate for hyperkalaemia: https://www.nice.org.uk/guidance/ta1148/chapter/1-Recommendations