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SZC Sodium Load Oedema Risk — ESENeph MCQ

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EasyElectrolyte DisordersSZC Sodium Load Oedema RiskESENeph

A 55-year-old man with CKD G4 is started on Sodium Zirconium Cyclosilicate (SZC) for chronic hyperkalaemia to enable continuation of Ramipril and Dapagliflozin. What important side effect should be monitored?

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Correct answer: A — SZC can cause oedema (exchanges potassium for sodium and hydrogen ions, providing a sodium load) – weight, BP, and fluid status should be monitored, particularly in CKD patients prone to fluid overload

SZC exchanges K+ for Na+ and H+ in the GI tract. The sodium exchange component can contribute to sodium and fluid retention, causing peripheral oedema and potentially worsening hypertension or heart failure. This is particularly relevant in CKD patients who already have impaired sodium excretion. NICE and BNF recommend monitoring for oedema and fluid overload. Dose adjustment or additional diuretic therapy may be needed. Despite this, the ability to maintain renoprotective RASi and SGLT2i therapy generally outweighs the manageable fluid retention risk.

Reference: BNF 2024 – SZC; NICE – SZC Evidence; KDIGO 2024 – CKD