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AstraZeneca reinforces commitment to advancing science for patients with chronic kidney disease and hyperkalemia at NKF Spring Clinical Meeting 2023

Real-world analysis from the REVOLUTIONIZE I study showed hyperkalemia was recurrent following dietary counselling

AstraZeneca will showcase five real-world evidence (RWE) studies from its industry-leading Cardiovascular, Renal and Metabolism (CVRM) portfolio, reinforcing its commitment to advancing science in chronic kidney disease (CKD) and hyperkalemia (HK), at the National Kidney Foundation (NKF) Spring Clinical Meeting April 11-15, 2023.

AstraZeneca will present data from the REVOLUTIONIZE I RWE study that show the recurrent nature of HK in patients with CKD and demonstrate the unmet need for these patients.1

Sarah Walters, Vice President, US Cardiovascular, Renal & Metabolic Diseases, AstraZeneca, said, “We are dedicated to advancing clinically effective therapies to better support patients living with chronic kidney disease and hyperkalemia. Our data at the NKF Spring Clinical Meeting demonstrate our commitment to science and the potential role our approved medicines may play in improving patient lives.”

Recurrence of HK following Medical Nutrition Therapy

REVOLUTIONIZE I was a retrospective, observational, RWE study of US electronic health records that evaluated the recurrence of HK following a medical nutrition therapy (MNT) visit, also referred to as dietary counselling, in 2,048 adults with HK and Stage 3 or 4 CKD. Patients were followed up for 6 months post-MNT and were censored when they died or initiated outpatient potassium binder therapy. The study found that the percentage of patients with CKD Stage 3/4 who had recurrent HK increased from 1 month (37.4%) to 6 months (56%). When looking at the patient population from first HK recurrence (n=842) to the fourth HK recurrence (n=204), the average time between recurrences progressively decreased to less than 30 days over time (from 45 days to 27 days) and the percentage of patients with HK recurrence increased in those with a prior recurrence (from 56% to 70%) during the 6-month follow up post-MNT.1

The RWE study highlights the unmet need to consider adding an oral anti-HK therapy like LOKELMA for treating patients with HK.1

The REVOLUTIONIZE RWE is part of the CRYSTALIZE evidence program, which is comprised of over 50 clinical and RWE studies researching the potential role of LOKELMA in the management of HK across the cardiorenal spectrum.

A comprehensive list of AstraZeneca key abstracts to be presented at the NKF Spring Clinical Meeting 2023 include:

Lead author

Abstract title

Presentation details



Dwyer J

Short-Term Cost Impact of Dapagliflozin in Chronic Kidney Disease

Poster #: 213

Hyperkalemia / LOKELMA

Rowan C

Recurrence of Hyperkalemia Following Dietary Counselling: REVOLUTIONIZE I Real-World Evidence Study

Poster #: 296

Agiro A

RAASi Optimization Among Patients Initiating SZC, OPTIMIZE I Real-World Evidence Study

Poster #: 282

Dwyer J

Impact of Sodium Zirconium Cyclosilicate Plus Renin-Angiotensin-Aldosterone System Inhibitor Therapy on Short-Term Medical Costs in Hyperkalemia: OPTIMIZE II study

Poster #: 284

Dwyer J

Medical Costs in Patients with Hyperkalemia on Long-Term Sodium Zirconium Cyclosilicate Therapy: RECOGNIZE II Study

Poster #: 285

NKF Spring Clinical Meeting 2023 abstracts are available online.

INDICATION AND LIMITATION OF USE FOR LOKELMA® (sodium zirconium cyclosilicate) 5 g and 10 g for oral suspension

LOKELMA is indicated for the treatment of hyperkalemia in adults. LOKELMA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.



  • Gastrointestinal Adverse Events in Patients with Motility Disorders: Avoid LOKELMA in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders. LOKELMA has not been studied in patients with these conditions and it may be ineffective and may worsen gastrointestinal conditions
  • Edema: Each 5-g dose of LOKELMA contains approximately 400 mg of sodium, but the extent of absorption by the patient is unknown. In clinical trials of LOKELMA in patients who were not on dialysis, edema was observed and was generally mild to moderate in severity and was more commonly seen in patients treated with 15 g once daily. Monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure or renal disease). Advise patients to adjust dietary sodium, if appropriate. Increase the dose of diuretics as needed

    In a clinical trial of LOKELMA in patients on chronic hemodialysis in which most patients were treated with doses of 5 g to 10 g once daily on non-dialysis days, there was no difference in the mean change from baseline in interdialytic weight gain (a measure of fluid retention) between the LOKELMA and placebo groups
  • Hypokalemia in Patients on Hemodialysis: Patients on hemodialysis may be prone to acute illness that can increase the risk of hypokalemia on LOKELMA (eg, illnesses associated with decreased oral intake, diarrhea). Consider adjusting LOKELMA dose based on potassium levels in these settings
  • Diagnostic Tests: LOKELMA has radio-opaque properties and, therefore, may give the appearance typical of an imaging agent during abdominal X-ray procedures

ADVERSE REACTIONS: The most common adverse reaction in non-dialysis patients with LOKELMA was mild to moderate edema. In placebo-controlled trials up to 28 days, edema was reported in 4.4%, 5.9%, 16.1% of non-dialysis patients treated with 5 g, 10 g, and 15 g of LOKELMA once daily, respectively vs 2.4% of non-dialysis patients receiving placebo.

DRUG INTERACTIONS: LOKELMA can transiently increase gastric pH. In general, oral medications with pH-dependent solubility should be administered at least 2 hours before or 2 hours after LOKELMA. Spacing is not needed if it has been determined the concomitant medication does not exhibit pH-dependent solubility.



FARXIGA is indicated:

  • as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
  • to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus and either established cardiovascular (CV) disease or multiple CV risk factors
  • to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure (NYHA class II-IV) with reduced ejection fraction
  • to reduce the risk of sustained eGFR decline, end stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression

FARXIGA is not recommended for patients with type 1 diabetes mellitus. It may increase the risk of diabetic ketoacidosis in these patients.

FARXIGA is not recommended for use to improve glycemic control in adults with type 2 diabetes mellitus with an eGFR less than 45 mL/min/1.73 m2. FARXIGA is likely to be ineffective in this setting based upon its mechanism of action.

FARXIGA is not recommended for the treatment of chronic kidney disease in patients with polycystic kidney disease or patients requiring or with a recent history of immunosuppressive therapy for kidney disease. FARXIGA is not expected to be effective in these populations.


To improve glycemic control, the recommended starting dose is 5 mg orally once daily. Dose can be increased to 10 mg orally once daily for additional glycemic control.

For all other indications, the recommended dose is 10 mg orally once daily.



  • Prior serious hypersensitivity reaction to FARXIGA
  • Patients on dialysis

Warnings and Precautions

  • Ketoacidosis in Diabetes Mellitus has been reported in patients with type 1 and type 2 diabetes receiving FARXIGA. In placebo-controlled trials of patients with type 1 diabetes, the risk of ketoacidosis was increased in patients who received SGLT2 inhibitors compared to patients who received placebo. Some cases were fatal. Assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue FARXIGA, evaluate and treat promptly. Before initiating FARXIGA, consider risk factors for ketoacidosis. Patients on FARXIGA may require monitoring and temporary discontinuation in situations known to predispose to ketoacidosis
  • Volume Depletion: FARXIGA can cause intravascular volume depletion which may manifest as symptomatic hypotension or acute transient changes in creatinine. Acute kidney injury requiring hospitalization and dialysis has been reported in patients with type 2 diabetes receiving SGLT2 inhibitors, including FARXIGA. Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m2), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. Before initiating FARXIGA in these patients, assess volume status and renal function. After initiating therapy, monitor for signs and symptoms of hypotension and renal function
  • Urosepsis and Pyelonephritis: SGLT2 inhibitors increase the risk for urinary tract infections (UTIs) and serious UTIs have been reported with FARXIGA. Evaluate for signs and symptoms of UTIs and treat promptly
  • Hypoglycemia: FARXIGA can increase the risk of hypoglycemia when coadministered with insulin and insulin secretagogues. Consider lowering the dose of these agents when coadministered with FARXIGA
  • Necrotizing Fasciitis of the Perineum (Fournier’s Gangrene): Rare but serious, life-threatening cases have been reported in patients with diabetes mellitus receiving SGLT2 inhibitors including FARXIGA. Cases have been reported in females and males. Serious outcomes have included hospitalization, surgeries, and death. Assess patients presenting with pain or tenderness, erythema, swelling in the genital or perineal area, along with fever or malaise. If suspected, institute prompt treatment and discontinue FARXIGA
  • Genital Mycotic Infections: FARXIGA increases the risk of genital mycotic infections, particularly in patients with prior genital mycotic infections. Monitor and treat appropriately

Adverse Reactions

In a pool of 12 placebo-controlled studies, the most common adverse reactions (≥5%) associated with FARXIGA 5 mg, 10 mg, and placebo respectively were female genital mycotic infections (8.4% vs 6.9% vs 1.5%), nasopharyngitis (6.6% vs 6.3% vs 6.2%), and urinary tract infections (5.7% vs 4.3% vs 3.7%).

Use in Specific Populations

  • Pregnancy: Advise females of potential risk to a fetus especially during the second and third trimesters
  • Lactation: FARXIGA is not recommended when breastfeeding

PLEASE SEE US Full Prescribing Information for FARXIGA.


AstraZeneca in CVRM

Cardiovascular, Renal and Metabolism (CVRM), part of BioPharmaceuticals, forms one of AstraZeneca’s three disease areas and is a key growth driver for the Company. By following the science to understand more clearly the underlying links between the heart, kidneys and pancreas, AstraZeneca is investing in a portfolio of medicines for organ protection and improving outcomes by slowing disease progression, reducing risks and tackling co-morbidities. The Company’s ambition is to modify or halt the natural course of CVRM diseases, and potentially regenerate organs and restore function, by continuing to deliver transformative science that improves treatment practices and CV health for millions of patients worldwide.

About AstraZeneca

AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines in Oncology, Rare Diseases and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries, and its innovative medicines are used by millions of patients worldwide. For more information, please visit and follow us on Twitter @AstraZenecaUS.


  1. Rowan CG, et al. Recurrence of hyperkalemia following dietary counselling, REVOLUTIONIZE I Real-World Evidence Study. Presented at National Kidney Foundation (NKF) Spring Clinical Meetings (SCM) 2023, 22-25 April, 2023, Austin, Texas, USA.

US-74793 Last Updated 4/23


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