SZC for Hyperkalemia After Adrenalectomy

Adrenalectomy is the leading treatment option for primary hyperaldosteronism, which can lead to hypertension, hypokalemia, and metabolic alkalosis. Although it is rare, hyperkalemia (HK) can occur after adrenalectomy because of the lack of aldosterone produced by the remaining adrenal gland.

In a presentation during the National Kidney Foundation Spring Clinical Meetings 2024, Anjali Patel and Tripti Singh, of the University of Wisconsin–Madison, discussed a case study of a patient with severe HK postadrenalectomy for primary hyperaldosteronism managed medically with sodium zirconium cyclosilicate (SZC).

The patient was 42 years old and male with a history of chronic kidney disease stage 3 (baseline serum creatinine, 2.39 mg/dL) and secondary hypertension due to primary hyperaldosteronism, requiring hydralazine (100.00 mg), carvedilol (6.25 mg), and nifedipine (60.00 mg). The man came to the emergency department with muscle cramping and lightheadedness 1 week after a right adrenalectomy. His blood pressure was 141/90 mm Hg, pulse was 67 bpm, serum creatinine was 3.05 mg/dL, sodium was 135 mmol/L, potassium was 7.2 mmol/L, and CO₂ was 15 mmol/L.

Amiloride was held, and the patient received SCZ (10 g) and sodium bicarbonate (1300 mg), both three times daily. The patient was discharged after 2 days with a serum potassium of 5.8 mmol/L. SZC was stopped at 8 months and 16 months after surgery but had to be reintroduced due to high serum potassium. It was stopped 20 months postsurgery when the patient’s serum potassium was 4.7 mmol/L; he was also receiving low-dose carvedilol and nifedipine for blood pressure control.

Patel and Singh concluded, “Severe hyperkalemia is rare but can be managed medically with SZC and sodium bicarbonate after adrenalectomy for primary hyperaldosteronism.”

Source: Patel A, Singh T. Use of sodium zirconium cyclosilicate for treatment of severe hyperkalemia post adrenalectomy for primary hyperaldosteronism. Presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.