Impact of Potassium‐Binders on the Interpretation of Bone Mineral Density Following Kidney Transplantation

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ABSTRACT Background Following kidney transplantation (KTx), episodes of hyperkalemia are common and effectively treated with sodium zirconium cyclosilicate (SZC, Lokelma) or patiromer (PAT, Veltassa). The presence of SZC/PAT in the gastrointestinal tract may, if radio dense, influence the interpretation of lumbar spine (LS) dual‐energy x‐ray absorptiometry (DXA)‐scans. We investigated the effect with/without PAT/SZC in KTx on LS DXA readings. Methods A prospective, single‐center study of KTx recipients in need of potassium‐lowering therapy was performed. All participants performed two LS DXA‐scans, the first after at least 3 days of SZC/PAT treatment and the second after a 2‐week washout. Results Eighteen KTx patients (8 SZC, 10 g/day vs. 10 PAT, 8.4 g/day) were included and provided two valid DXA‐scans (mean age 63 ± 12 years, 12 males). The change in LS BMD determinations in the SZC group was 2.48 ±12.21%, while there was no change in the PAT group, ‐0.25 ± 2.28%. The absolute root mean squared difference (RMSD) change was 0.102 ± 0.084 g/cm 2 and 0.021 ±0.013 g/cm 2 after SZC and PAT washout, respectively ( p = 0.008). Conclusion In KTx, treatment with SZC, but not PAT, significantly influenced the DXA‐scan interpretation of the LS region. After a 2‐week washout period, SZC interference was without clinical implications on DXA‐scans. Summary The potassium lowering drug sodium zirconium cyclosilicate (Lokelma) is radiopaque and therefore acts as a confounder on DXA interpretations in kidney transplant recipients. Patiromer (PAT, Veltassa) has no such effect.

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