Efficacy and safety of sodium zirconium cyclosilicate in patients with baseline serum potassium level ≥ 5.5 mmol/L: pooled analysis from two phase 3 trials.

BackgroundReliable, timely-onset, oral treatments with an acceptable safety profile for patients with hyperkalemia are needed. We examined the efficacy and safety of sodium zirconium cyclosilicate (SZC; formerly ZS-9) treatment for ≤ 48 h in patients with baseline serum potassium level ≥ 5.5 mmol/L.MethodsData were pooled from two phase 3 studies (ZS-003 and HARMONIZE) among patients receiving SZC 10 g three times daily. Outcomes included mean and absolute change from baseline, median time to potassium level ≤ 5.5 and ≤ 5.0 mmol/L, and proportion achieving potassium level ≤ 5.5 and ≤ 5.0 mmol/L at 4, 24, and 48 h. Outcomes were stratified by baseline potassium. Safety outcomes were evaluated.ResultsAt baseline, 125 of 170 patients (73.5%) had potassium level 5.5-< 6.0, 39 (22.9%) had potassium level 6.0-6.5, and 6 (3.5%) had potassium level > 6.5 mmol/L. Regardless of baseline potassium, mean potassium decreased at 1 h post-initial dose. By 4 and 48 h, 37.5% and 85.0% of patients achieved potassium level ≤ 5.0 mmol/L, respectively. Median (95% confidence interval) times to potassium level ≤ 5.5 and ≤ 5.0 mmol/L were 2.0 (1.1-2.0) and 21.6 (4.1-22.4) h, respectively. Fifteen patients (8.8%) experienced adverse events; none were serious.ConclusionsSZC 10 g three times daily achieved serum potassium reduction and normokalemia, with a favorable safety profile.Trial registrationClinicalTrials.gov identifiers: ZS-003: NCT01737697 and HARMONIZE: NCT02088073

Zn(Ii) and Cu(Ii) Adsorption and Retention Onto Iron Oxyhydroxide Nanoparticles: Effects Of Particle Aggregation and Salinity

Background: Iron oxyhydroxides are commonly found in natural aqueous systems as nanoscale particles, where they can act as effective sorbents for dissolved metals due to their natural surface reactivity, small size and high surface area. These properties make nanoscale iron oxyhydroxides a relevant option for the remediation of water supplies contaminated with dissolved metals. However, natural geochemical processes, such as changes in ionic strength, pH, and temperature, can cause these particles to aggregate, thus affecting their sorption capabilities and remediation potential. Other environmental parameters such as increasing salinity may also impact metal retention, e. g. when particles are transported from freshwater to seawater. Results: After using synthetic iron oxyhydroxide nanoparticles and nanoparticle aggregates in batch Zn(II) adsorption experiments, the addition of increasing concentrations of chloride (from 0.1 M to 0.6 M) appears to initially reduce Zn (II) retention, likely due to the desorption of outer-sphere zinc surface complexes and subsequent formation of aqueous Zn-Cl complexes, before then promoting Zn(II) retention, possibly through the formation of ternary surface complexes (supported by EXAFS spectroscopy) which stabilize zinc on the surface of the nanoparticles/aggregates. In batch Cu(II) adsorption experiments, Cu(II) retention reaches a maximum at 0.4 M chloride. Copper-chloride surface complexes are not indicated by EXAFS spectroscopy, but there is an increase in the formation of stable aqueous copper-chloride complexes as chloride concentration rises (with CuCl+ becoming dominant in solution at similar to 0.5 M chloride) that would potentially inhibit further sorption or encourage desorption. Instead, the presence of bidentate edge-sharing and monodentate corner-sharing complexes is supported by EXAFS spectroscopy. Increasing chloride concentration has more of an impact on zinc retention than the mechanism of nanoparticle aggregation, whereas aggregation condition is a stronger determinant of copper retention. Conclusions: Based on these model uptake/retention studies, iron oxyhydroxide nanoparticles show potential as a strategy to remediate zinc-contaminated waters that migrate towards the ocean. Copper retention, in contrast, appears to be optimized at an intermediate salinity consistent with brackish water, and therefore may release considerable fractions of retained copper at higher (e. g. seawater) salinity levels

Sulfate Enhances the Adsorption and Retention of Cu(II) and Zn(II) to Dispersed and Aggregated Iron Oxyhydroxide Nanoparticles

The adsorption and retention of metal ions to nanoscale iron (hydr)oxides in aqueous systems is significantly influenced by prevailing environmental conditions. We examined the influence of sulfate, the second most common anion in seawater that is present in many other natural aquatic systems, on the adsorption and retention of Cu(II) and Zn(II) to synthetic iron oxyhydroxide nanoparticles (NPs) and their aggregates. Batch uptake experiments with monodisperse NPs and NPs aggregated by changes in pH, ionic strength, and temperature were conducted over sulfate concentrations ranging from 0 to 0.30 M. The introduction of 0.03 M sulfate significantly increased the initial adsorption and retention of Zn(II) and Cu(II) compared to sulfate-free conditions; with increasing sulfate \u3e0.03 M, Zn(II) retention continuously increased, while Cu(II) retention was considerably more variable but increased slightly. NP aggregation, when induced by pH and ionic strength, was positively correlated with metal ion retention, while aggregation temperature was negatively correlated with both adsorption and retention. Aqueous geochemical modeling indicated that Zn(II) readily complexes with sulfate to form ZnSO4 (aq), but that stable aqueous CuSO4 species are uncommon. EXAFS spectroscopic analysis suggests structural incorporation of Zn(II) and Zn(II)-sulfate ternary surface complexation, while Cu(II) primarily forms inner-sphere bidentate surface complexes. Collectively, the effects of sulfate in both reducing surface charge repulsion, initiating ternary surface complexation, and enabling structural incorporation aid to enhance both metal adsorption and retention to iron oxyhydroxide NPs and their aggregates

Editorial: Multi-Omics Technologies for Optimizing Synthetic Biomanufacturing

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