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Open-label Safety of Sodium Zirconium Cyclosilicate for up to 12 Months in Japanese Subjects With Hyperkalemia

A Phase 3 Multicenter Open-label Maintenance Study to Investigate the Long-term Safety of ZS (Sodium Zirconium Cyclosilicate) in Japanese Subjects With Hyperkalemia

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03172702
Enrollment
150
Registered
2017-06-01
Start date
2017-09-04
Completion date
2019-07-06
Last updated
2020-05-01

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hyperkalemia

Brief summary

The Open-Label Maintenance Study contains an Correction Phase, in which subjects will be dosed with ZS 10 g three times daily (tid) for 24 to 72 hours, followed by a 12-month long-term Maintenance Phase.

Detailed description

The study will start with the screening period, and all baseline parameters should be measured/collected up to 1 day prior to administration of first dose of study drug on Correction Phase Day 1. Subjects with 2 consecutive i-STAT potassium values ≥ 5.1 mmol/L will enter the Correction Phase and receive ZS 10 g TID for up to 72 hours, depending on potassium values. Once normokalemia (i-STAT potassium between 3.5 and 5.0 mmol/L, inclusive) is restored (whether after 24, 48 or 72 hours), subjects will be entered into the Maintenance Phase to be dosed with ZS at a starting dose of 5 g QD. Potassium (i-STAT and Central Laboratory) will be measured Days 1, 2, 5, 12, 19 and 26 throughout the first month of study and every 4 weeks thereafter until Day 362 (Visit 23) then patients will be required to complete the EOS visit which is 7±1 days after the last administration of study medication. For patients who do not enter the Maintenance Phase the last visit will be 7±1 day after the last treatment dose in the Correction Phase. The total expected study duration for an individual patient is approximately 53-54 weeks.

Interventions

DRUGZirconium Cyclosilicate

Correction Phase Dosing: Sodium Zirconium Cyclosilicate 10 g three times daily (TID) from 24 to 72 Extended Dosing: Sodium Zirconium Cyclosilicate 5 g once daily (QD). Sodium Zirconium Cyclosilicate dose increased or decreased in increments/decrements of 5 g QD up to a maximum of 15 g QD or a minimum of 5 g every other day (QOD) (or 2.5 g QD) based on i-STAT potassium measurements up to 12 months.

Sponsors

AstraZeneca
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 130 Years
Healthy volunteers
No

Inclusion criteria

* Provision of informed consent prior to any study specific procedures. * Patients aged ≥18. For patients aged \<20 years, a written informed consent should be obtained from the patient and his or her legally acceptable representative. * Two consecutive i-STAT potassium values, measured 60-minutes (± 15 minutes) apart, both ≥ 5.1 mmol/L and measured within 1 day before the first dose of ZS on Correction Phase Study Day 1. * Patients who are on peritoneal dialysis (PD) can be enrolled if their SK level is ≥5.5 and ≤ 6.5 mmol/L in two consecutive i-STAT potassium evaluation at least 24 hours apart before Day 1 (in each evaluation, two i-STAT potassium measurements at least 1 hour apart are required). i-STAT potassium measurement should be performed in the morning before breakfast and in the evening before dinner in PD patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), respectively. * Women of childbearing potential must be using 2 forms of medically acceptable contraception (at least 1 barrier method) and have a negative pregnancy test within 1 day prior to the first dose of ZS on Correction Phase Study Day 1. Women who are surgically sterile or those who are postmenopausal for at least 1 year are not considered to be of childbearing potential.

Exclusion criteria

* Patients treated with lactulose, rifaxan (rifaximin), or other non-absorbed antibiotics for hyperammonemia within 7 days prior to first dose of ZS. * Patients treated with resins (such as sevelamer hydrochloride, sodium polystyrene sulfonate \[SPS; e.g. Kayexalate®\] or calcium polystyrene sulfonate \[CPS\]), calcium acetate, calcium carbonate, or lanthanum carbonate, within 7 days prior to the first dose of study drug. Washout of SPS and CPS for 7 days (or longer) prior to the first dose of ZS is allowed, if termination of CPS or SPS is judged to be clinically acceptable by the investigator. Documented informed consent has to be obtained prior to the washout. * Patients with a life expectancy of less than 12 months * Female patients who are pregnant, lactating, or planning to become pregnant * Patients who have an active or history of diabetic ketoacidosis * Known hypersensitivity or previous anaphylaxis to ZS or to components thereof * Treatment with a drug or device within the last 30 days that has not received regulatory approval at the time of study entry. * Patients with cardiac arrhythmias that require immediate treatment * Hemodialysis patients (including those who are on both PD and hemodialysis \[HD\]) * Patients who have been on PD less than 6 months or more than 6 months with a history of hypokalemia within 6 months before Correction Phase Day 1 * Documented Glomerular Filtration Rate (GFR) \< 15 mL/min within 90 days prior to study entry (Non peritoneal dialysis (PD) patients only) * If patients joined ZS study in the past, the patients cannot join this study within the last 30 days of the last study drug administration day.

Design outcomes

Primary

MeasureTime frameDescription
Number of Patients Who Experienced Adverse Events (AEs) in the MPFirst MP dose up to 1 day (2 days for QOD regimen) after last MP dose.The number of patients who experienced any AE, including those which were serious (SAE), had an outcome of death, were severe, led to discontinuation of ZS or were causally related to ZS are presented for the MP. AEs of special interest are also presented, including oedema-related AEs, cardiac failure and hypertension.

Secondary

MeasureTime frameDescription
Percentage of Patients Who Were Normokalemic in the MPMP Day 1 to End of Study visit (up to 12 months).The percentage of patients who were normokalemic at each study visit in the MP is presented. Normokalemia was defined as a serum potassium (S-K) level of ≥ 3.5 and ≤ 5.0 mmol/L. The percentage of patients who were normokalemic at their last on-treatment visit is also presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days on QOD regimen) after the last ZS dose. End of Study was defined as the last ZS dose + 7 days.
Percentage of Patients With Average S-K Levels of ≤5.1 mmol/L and ≤5.5 mmol/L in the MPMP Day 2 to Day 362.The percentage of patients who had an average S-K level of ≤5.1 mmol/L and ≤5.5 mmol/L over the MP up to Day 362 is presented.
Percentage of Patients Who Were Hypokalemic in the MPMP Day 1 to End of Study visit (up to 12 months).The percentage of patients who were hypokalemic at each study visit in the MP is presented. Hypokalemia was defined as a S-K level of \< 3.5 mmol/L. The percentage of patients who were hypokalemic at their last on-treatment visit is also presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days on QOD regimen) after the last ZS dose. End of Study was defined as the last ZS dose + 7 days.
Percentage of Patients Who Were Hyperkalemic in the MPMP Day 1 to End of Study visit (up to 12 months).The percentage of patients who were hyperkalemic at each study visit in the MP is presented. Hyperkalemia was defined as a S-K level of \>5.0 mmol/L. The percentage of patients who were hyperkalemic at their last on-treatment visit is also presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days on QOD regimen) after the last ZS dose. End of Study was defined as the last ZS dose + 7 days.
Mean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPCP Day 1 to MP Day 362.The mean changes from the CP baseline in S-K level over specified periods of time in the MP are presented. Baseline for the CP was defined as the mean of 2 different S-K values, recorded 60 minutes apart (to confirm qualification for study entry) on the CP Day 1.
Mean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 1 to Day 362.The mean changes from the MP baseline in S-K level over specified periods of time in the MP are presented. Baseline for the MP was defined as the measurement taken in the morning of the day of entering the MP (MP Day 1).
Mean Number of Normokalemic Days During the MPMP Day 1 to Day 362.The number of normokalemic days during the MP was calculated assuming the time interval between assessments was normokalemic if both the beginning and end assessments for that time interval displayed normal S-K values. If an intermediate scheduled assessment time point was missing, then the scheduled assessment was regarded as not normokalemic. The mean number of normokalemic days for a patient in the MP is presented.
Percentage of Patients Who Were Normokalemic in the CPCP Day 1 to Day 3.The percentage of patients who were normokalemic at 24, 48 and 72 hours in the CP is presented. Normokalemia was defined as a S-K level of ≥ 3.5 and ≤ 5.0 mmol/L.
Change From CP Baseline in S-Aldosterone Levels Over the MPCP Day 1, MP Day 166 and MP Day 362.The mean change from CP baseline to MP Day 166 and MP Day 362 in S-aldosterone levels is presented. In addition, the mean change from CP baseline to the last on-treatment value is presented. The CP baseline was defined as the last S-aldosterone assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose.
Percentage of Patients With Normal S-Aldosterone Levels Over the MPCP Day 1, MP Day 166 and MP Day 362.The percentage of patients with normal S-aldosterone levels up to Day 362 of the MP is presented. The normal range for S-aldosterone was 0 - 776.72 pmol/L. In addition, the percentage of patients with normal S-aldosterone levels at the last on-treatment visit is presented. The CP baseline was defined as the last S-aldosterone assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose.
Change From CP Baseline in S-Bicarbonate Levels Over the MPCP Day 1, and MP Day 1 to End of Study visit (up to 12 months).The mean change from CP baseline to timepoints in the MP in S-bicarbonate levels is presented. In addition, the mean change from CP baseline to the last on-treatment value is presented. The CP baseline was defined as the last S-bicarbonate assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose. The End of Study was 7 days after the last ZS dose.
Percentage of Patients With Normal S-Bicarbonate Levels Over the MPCP Day 1 and MP Day 1 to End of Study visit (up to 12 months).The percentage of patients with normal S-bicarbonate levels up to the End of Study visit in the MP is presented. The normal range for S-bicarbonate was 17 - 32 mmol/L. In addition, the percentage of patients with normal S-bicarbonate levels at the last on-treatment visit is presented. The CP baseline was defined as the last S-bicarbonate assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose. The End of Study was 7 days after the last ZS dose.
Baseline and Post-baseline 36-Item Short Form Health Survey Version 2 (SF-36 v2) Physical Component Summary (PCS) and Mental Component Summary (MCS) ScoresCP Day 1 (baseline) and MP Day 362 (post-baseline).Patients completed the SF-36 v2 questionnaire on Day 1 of the CP and on Day 362 of the MP. The responses to the items assessing the physical and mental health of the patients determined the PCS and MCS based on a standard algorithm. The PCS and MCS scores ranged from 0 (worst possible health state) to 100 (best possible health state). The mean PCS and MCS are presented for the baseline and post-baseline assessments.
Mean Change From CP Baseline in the Mean S-K Levels in the CPCP Day 1 to Day 3.The mean change from the CP baseline at 24, 48 and 72 hours in the CP is presented. The mean change from baseline to the last on-treatment CP value is also presented. The last on-treatment value was defined as the last measurement taken with 1 day (2 days if on the QOD regimen) after the last ZS dose. Baseline for the CP was defined as the mean of 2 different S-K values, recorded 60 minutes apart (to confirm qualification for study entry) on the CP Day 1.
Number of Patients Who Experienced AEs in the CPDay 1 of CP to last CP dose + 1 day or first MP dose -1 day, earlier.The number of patients who experienced any AE, including SAEs, those which had an outcome of death, were severe, led to discontinuation of ZS or were causally related to ZS are presented for the CP. AEs of special interest are also presented, including oedema-related AEs, cardiac failure and hypertension.
Mean Change in S-K Level From Last On-treatment MP Visit to the End of StudyMP Day 1 to End of Study visit (up to 12 months).The mean change in the S-K level from the last on-treatment MP visit to the End of Study is presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose. The End of Study was 7 days after the last ZS dose.

Countries

Japan

Participant flow

Recruitment details

Japanese patients with hyperkalemia were recruited to this open-label, single-arm study with a flexible dosing regimen conducted in 44 study centers in Japan. First patient enrolled in September 2017; last patient completed in July 2019.

Pre-assignment details

For inclusion, patients were required to have 2 consecutive iSTAT (portable blood analyzer) potassium values, measured 60 minutes apart, both ≥5.1 millimole per liter (mmol/L) and measured within 1 day before the first dose of sodium zirconium cyclosilicate (ZS) on Correction Phase (CP) Day 1.

Participants by arm

ArmCount
Sodium Zirconium Cyclosilicate
CP (up to 3 days): Patients received 10 g ZS TID for a maximum of 72 hours. MP (up to 12 months): Patients received a starting dose of 5 g ZS QD which could be increased to 10 g or 15 g QD or decreased to 5 g QOD or 2.5 g QD.
150
Total150

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdverse Event9
Overall StudyDeath2
Overall StudyOther2
Overall StudyStudy-specific Withdrawal Criteria10
Overall StudyWithdrawal by Subject5

Baseline characteristics

CharacteristicSodium Zirconium Cyclosilicate
Age, Continuous71.5 years
STANDARD_DEVIATION 10.8
Race/Ethnicity, Customized
Asian
150 Participants
Sex: Female, Male
Female
38 Participants
Sex: Female, Male
Male
112 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 1502 / 150
other
Total, other adverse events
1 / 15079 / 150
serious
Total, serious adverse events
1 / 15027 / 150

Outcome results

Primary

Number of Patients Who Experienced Adverse Events (AEs) in the MP

The number of patients who experienced any AE, including those which were serious (SAE), had an outcome of death, were severe, led to discontinuation of ZS or were causally related to ZS are presented for the MP. AEs of special interest are also presented, including oedema-related AEs, cardiac failure and hypertension.

Time frame: First MP dose up to 1 day (2 days for QOD regimen) after last MP dose.

Population: The safety analysis set for the MP (SAF-MP) included all patients treated with at least 1 dose of MP ZS and who had any MP safety data.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPOedema-related AE31 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPAny AE131 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPAny AE with outcome death2 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPAny SAE27 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPAny severe AE9 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPAny AE leading to ZS discontinuation12 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPAny causally related AE30 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPCardiac failure10 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced Adverse Events (AEs) in the MPHypertension24 Participants
Secondary

Baseline and Post-baseline 36-Item Short Form Health Survey Version 2 (SF-36 v2) Physical Component Summary (PCS) and Mental Component Summary (MCS) Scores

Patients completed the SF-36 v2 questionnaire on Day 1 of the CP and on Day 362 of the MP. The responses to the items assessing the physical and mental health of the patients determined the PCS and MCS based on a standard algorithm. The PCS and MCS scores ranged from 0 (worst possible health state) to 100 (best possible health state). The mean PCS and MCS are presented for the baseline and post-baseline assessments.

Time frame: CP Day 1 (baseline) and MP Day 362 (post-baseline).

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateBaseline and Post-baseline 36-Item Short Form Health Survey Version 2 (SF-36 v2) Physical Component Summary (PCS) and Mental Component Summary (MCS) ScoresBaseline: PCS49.106 Scale scoreStandard Deviation 6.292
Sodium Zirconium CyclosilicateBaseline and Post-baseline 36-Item Short Form Health Survey Version 2 (SF-36 v2) Physical Component Summary (PCS) and Mental Component Summary (MCS) ScoresPost-baseline: PCS49.348 Scale scoreStandard Deviation 6.659
Sodium Zirconium CyclosilicateBaseline and Post-baseline 36-Item Short Form Health Survey Version 2 (SF-36 v2) Physical Component Summary (PCS) and Mental Component Summary (MCS) ScoresBaseline: MCS51.126 Scale scoreStandard Deviation 8.375
Sodium Zirconium CyclosilicateBaseline and Post-baseline 36-Item Short Form Health Survey Version 2 (SF-36 v2) Physical Component Summary (PCS) and Mental Component Summary (MCS) ScoresPost-baseline: MCS50.350 Scale scoreStandard Deviation 8.384
Secondary

Change From CP Baseline in S-Aldosterone Levels Over the MP

The mean change from CP baseline to MP Day 166 and MP Day 362 in S-aldosterone levels is presented. In addition, the mean change from CP baseline to the last on-treatment value is presented. The CP baseline was defined as the last S-aldosterone assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose.

Time frame: CP Day 1, MP Day 166 and MP Day 362.

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Aldosterone Levels Over the MPMP Day 166-56.355 Picomole per liter (pmol/L)Standard Deviation 124.05
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Aldosterone Levels Over the MPMP Day 362-48.561 Picomole per liter (pmol/L)Standard Deviation 129.261
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Aldosterone Levels Over the MPLast on-treatment Visit-48.808 Picomole per liter (pmol/L)Standard Deviation 125.081
Secondary

Change From CP Baseline in S-Bicarbonate Levels Over the MP

The mean change from CP baseline to timepoints in the MP in S-bicarbonate levels is presented. In addition, the mean change from CP baseline to the last on-treatment value is presented. The CP baseline was defined as the last S-bicarbonate assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose. The End of Study was 7 days after the last ZS dose.

Time frame: CP Day 1, and MP Day 1 to End of Study visit (up to 12 months).

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 11.20 mmol/LStandard Deviation 1.64
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 51.20 mmol/LStandard Deviation 1.71
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 121.46 mmol/LStandard Deviation 1.91
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 191.29 mmol/LStandard Deviation 2.27
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 261.64 mmol/LStandard Deviation 2.22
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 821.45 mmol/LStandard Deviation 2.9
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 1661.55 mmol/LStandard Deviation 2.53
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 2501.84 mmol/LStandard Deviation 2.64
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 3341.73 mmol/LStandard Deviation 2.75
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPMP Day 3621.50 mmol/LStandard Deviation 2.85
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPLast on-treatment Visit1.70 mmol/LStandard Deviation 2.87
Sodium Zirconium CyclosilicateChange From CP Baseline in S-Bicarbonate Levels Over the MPEnd of Study Visit0.55 mmol/LStandard Deviation 2.49
Secondary

Mean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MP

The mean changes from the CP baseline in S-K level over specified periods of time in the MP are presented. Baseline for the CP was defined as the mean of 2 different S-K values, recorded 60 minutes apart (to confirm qualification for study entry) on the CP Day 1.

Time frame: CP Day 1 to MP Day 362.

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 1-0.93 mmol/LStandard Deviation 0.44
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPEntire MP (Day 2 to Day 362)-0.98 mmol/LStandard Deviation 0.42
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 82 to Day 362-1.07 mmol/LStandard Deviation 0.52
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 2 to Day 82-0.91 mmol/LStandard Deviation 0.41
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 110 to Day 166-1.11 mmol/LStandard Deviation 0.61
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 194 to Day 278-1.01 mmol/LStandard Deviation 0.51
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 306 to Day 362-1.06 mmol/LStandard Deviation 0.55
Secondary

Mean Change From CP Baseline in the Mean S-K Levels in the CP

The mean change from the CP baseline at 24, 48 and 72 hours in the CP is presented. The mean change from baseline to the last on-treatment CP value is also presented. The last on-treatment value was defined as the last measurement taken with 1 day (2 days if on the QOD regimen) after the last ZS dose. Baseline for the CP was defined as the mean of 2 different S-K values, recorded 60 minutes apart (to confirm qualification for study entry) on the CP Day 1.

Time frame: CP Day 1 to Day 3.

Population: The CP full analysis set (FAS-CP) included all patients who received at least 1 dose of ZS during the CP and who had any post-baseline CP S-K values.

ArmMeasureGroupValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Levels in the CP24 hours-0.78 mmol/LStandard Deviation 0.39
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Levels in the CP48 hours-1.30 mmol/LStandard Deviation 0.39
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Levels in the CP72 hoursNA mmol/L
Sodium Zirconium CyclosilicateMean Change From CP Baseline in the Mean S-K Levels in the CPLast on-treatment Visit-0.93 mmol/LStandard Deviation 0.44
Secondary

Mean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MP

The mean changes from the MP baseline in S-K level over specified periods of time in the MP are presented. Baseline for the MP was defined as the measurement taken in the morning of the day of entering the MP (MP Day 1).

Time frame: MP Day 1 to Day 362.

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateMean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MPEntire MP (Day 2 to Day 362)-0.07 mmol/LStandard Deviation 0.33
Sodium Zirconium CyclosilicateMean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 82 to Day 362-0.14 mmol/LStandard Deviation 0.42
Sodium Zirconium CyclosilicateMean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 2 to Day 82-0.01 mmol/LStandard Deviation 0.36
Sodium Zirconium CyclosilicateMean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 110 to Day 166-0.16 mmol/LStandard Deviation 0.5
Sodium Zirconium CyclosilicateMean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 194 to Day 278-0.07 mmol/LStandard Deviation 0.42
Sodium Zirconium CyclosilicateMean Change From MP Baseline in the Mean S-K Level Over Specified Time Periods in the MPMP Day 306 to Day 362-0.11 mmol/LStandard Deviation 0.47
Secondary

Mean Change in S-K Level From Last On-treatment MP Visit to the End of Study

The mean change in the S-K level from the last on-treatment MP visit to the End of Study is presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose. The End of Study was 7 days after the last ZS dose.

Time frame: MP Day 1 to End of Study visit (up to 12 months).

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateMean Change in S-K Level From Last On-treatment MP Visit to the End of Study0.66 mmol/LStandard Deviation 0.53
Secondary

Mean Number of Normokalemic Days During the MP

The number of normokalemic days during the MP was calculated assuming the time interval between assessments was normokalemic if both the beginning and end assessments for that time interval displayed normal S-K values. If an intermediate scheduled assessment time point was missing, then the scheduled assessment was regarded as not normokalemic. The mean number of normokalemic days for a patient in the MP is presented.

Time frame: MP Day 1 to Day 362.

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureValue (MEAN)Dispersion
Sodium Zirconium CyclosilicateMean Number of Normokalemic Days During the MP207.7 DaysStandard Deviation 109.5
Secondary

Number of Patients Who Experienced AEs in the CP

The number of patients who experienced any AE, including SAEs, those which had an outcome of death, were severe, led to discontinuation of ZS or were causally related to ZS are presented for the CP. AEs of special interest are also presented, including oedema-related AEs, cardiac failure and hypertension.

Time frame: Day 1 of CP to last CP dose + 1 day or first MP dose -1 day, earlier.

Population: The SAF-CP included all patients treated with at least 1 dose of CP ZS and who had any CP safety data.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPAny AE5 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPAny AE with outcome death0 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPAny SAE1 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPAny severe AE0 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPAny AE leading to ZS discontinuation0 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPAny causally related AE0 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPOedema-related AE0 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPCardiac failure0 Participants
Sodium Zirconium CyclosilicateNumber of Patients Who Experienced AEs in the CPHypertension0 Participants
Secondary

Percentage of Patients Who Were Hyperkalemic in the MP

The percentage of patients who were hyperkalemic at each study visit in the MP is presented. Hyperkalemia was defined as a S-K level of \>5.0 mmol/L. The percentage of patients who were hyperkalemic at their last on-treatment visit is also presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days on QOD regimen) after the last ZS dose. End of Study was defined as the last ZS dose + 7 days.

Time frame: MP Day 1 to End of Study visit (up to 12 months).

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (NUMBER)
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 118.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 221.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 520.1 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 1232.2 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 1934.5 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 2627.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 5420.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 8224.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 11023.4 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 13812.7 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 16620.5 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 19423.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 22227.9 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 25017.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 27822.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 30624.2 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 33415.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPMP Day 36218.9 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPLast on-treatment Visit16.7 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hyperkalemic in the MPEnd of Study Visit61.0 Percentage of patients
Secondary

Percentage of Patients Who Were Hypokalemic in the MP

The percentage of patients who were hypokalemic at each study visit in the MP is presented. Hypokalemia was defined as a S-K level of \< 3.5 mmol/L. The percentage of patients who were hypokalemic at their last on-treatment visit is also presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days on QOD regimen) after the last ZS dose. End of Study was defined as the last ZS dose + 7 days.

Time frame: MP Day 1 to End of Study visit (up to 12 months).

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (NUMBER)
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 10.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 20.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 50.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPDay 120.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 190.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 260.7 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 542.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 823.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 1100.7 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 1382.2 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 1661.5 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 1940.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 2221.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 2502.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 2781.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 3061.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 3341.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPMP Day 3621.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPLast on-treatment Visit5.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Hypokalemic in the MPEnd of Study Visit0.7 Percentage of patients
Secondary

Percentage of Patients Who Were Normokalemic in the CP

The percentage of patients who were normokalemic at 24, 48 and 72 hours in the CP is presented. Normokalemia was defined as a S-K level of ≥ 3.5 and ≤ 5.0 mmol/L.

Time frame: CP Day 1 to Day 3.

Population: The FAS-CP included all patients who received at least 1 dose of ZS during the CP and who had any post-baseline CP S-K values.

ArmMeasureGroupValue (NUMBER)
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the CP24 hours65.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the CP48 hours81.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the CP72 hours82.0 Percentage of patients
Secondary

Percentage of Patients Who Were Normokalemic in the MP

The percentage of patients who were normokalemic at each study visit in the MP is presented. Normokalemia was defined as a serum potassium (S-K) level of ≥ 3.5 and ≤ 5.0 mmol/L. The percentage of patients who were normokalemic at their last on-treatment visit is also presented. The last on-treatment value was defined as the last measurement taken within 1 day (2 days on QOD regimen) after the last ZS dose. End of Study was defined as the last ZS dose + 7 days.

Time frame: MP Day 1 to End of Study visit (up to 12 months).

Population: The full analysis set for the MP (FAS-MP) included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (NUMBER)
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 182.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 278.7 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 579.9 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 1267.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 1965.5 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 2672.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 5476.4 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 8272.1 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 11075.9 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 13885.1 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 16678.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 19475.4 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 22270.5 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 25079.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 27875.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 30674.2 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 33483.1 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPMP Day 36279.5 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPLast on-treatment Visit78.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients Who Were Normokalemic in the MPEnd of Study Visit38.4 Percentage of patients
Secondary

Percentage of Patients With Average S-K Levels of ≤5.1 mmol/L and ≤5.5 mmol/L in the MP

The percentage of patients who had an average S-K level of ≤5.1 mmol/L and ≤5.5 mmol/L over the MP up to Day 362 is presented.

Time frame: MP Day 2 to Day 362.

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (NUMBER)
Sodium Zirconium CyclosilicatePercentage of Patients With Average S-K Levels of ≤5.1 mmol/L and ≤5.5 mmol/L in the MP≤5.1 mmol/L93.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Average S-K Levels of ≤5.1 mmol/L and ≤5.5 mmol/L in the MP≤5.5 mmol/L100.0 Percentage of patients
Secondary

Percentage of Patients With Normal S-Aldosterone Levels Over the MP

The percentage of patients with normal S-aldosterone levels up to Day 362 of the MP is presented. The normal range for S-aldosterone was 0 - 776.72 pmol/L. In addition, the percentage of patients with normal S-aldosterone levels at the last on-treatment visit is presented. The CP baseline was defined as the last S-aldosterone assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose.

Time frame: CP Day 1, MP Day 166 and MP Day 362.

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (NUMBER)
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Aldosterone Levels Over the MPCP Baseline99.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Aldosterone Levels Over the MPMP Day 166100.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Aldosterone Levels Over the MPMP Day 362100.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Aldosterone Levels Over the MPLast on-treatment Visit100.0 Percentage of patients
Secondary

Percentage of Patients With Normal S-Bicarbonate Levels Over the MP

The percentage of patients with normal S-bicarbonate levels up to the End of Study visit in the MP is presented. The normal range for S-bicarbonate was 17 - 32 mmol/L. In addition, the percentage of patients with normal S-bicarbonate levels at the last on-treatment visit is presented. The CP baseline was defined as the last S-bicarbonate assessment immediately prior to the start of the first dose of ZS during the CP. The last on-treatment value was defined as the last measurement taken within 1 day (2 days if on QOD regimen) after the last ZS dose. The End of Study was 7 days after the last ZS dose.

Time frame: CP Day 1 and MP Day 1 to End of Study visit (up to 12 months).

Population: The FAS-MP included all patients who received at least 1 dose of ZS during the MP and who had any post-baseline MP S-K values.

ArmMeasureGroupValue (NUMBER)
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPCP Baseline90.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 198.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 598.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 1298.0 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 1997.3 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 2698.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 8297.8 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 16699.2 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 25099.2 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 33497.6 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPMP Day 36295.9 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPLast on-treatment Visit96.7 Percentage of patients
Sodium Zirconium CyclosilicatePercentage of Patients With Normal S-Bicarbonate Levels Over the MPEnd of Study Visit93.8 Percentage of patients

Source: ClinicalTrials.gov · Data processed: Feb 26, 2026