Advances in Hyperkalemia Management and the Emerging Role of Sodium Zirconium Cyclosilicate

Hyperkalemia is a common and potentially life-threatening complication in patients with chronic kidney disease and heart failure. It also represents a major barrier to the optimal use of renin-angiotensin-aldosterone system inhibitors (RAASi), which are central to improving cardiorenal outcomes. Contemporary guidance, including the 2025 Korean Society of Nephrology Practical Recommendations for the Management of Hypertensive Kidney Disease, emphasizes the maintenance of normokalemia as a key strategy for enabling continuation and optimization of RAASi therapy. Sodium zirconium cyclosilicate (SZC) supports this therapeutic paradigm by enabling rapid potassium reduction and sustained potassium control. This review repositions hyperkalemia as a modifiable barrier to guideline-directed therapy and summarizes the pharmacology, clinical evidence, and practical considerations related to SZC use in patients at high cardiorenal risk.