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NCT01493024

Safety & Efficacy of Zirconium Silicate in Chronic Kidney Disease or Moderate Kidney Dysfunction With Mild Hyperkalemia

Completed Phase 2 Results posted Last updated 29 June 2018
What this trial tests

Phase 2 trial testing Zirconium silicate (ZS) in Hyperkalemia in 90 participants. Completed in 30 June 2012.

Timeline
30 November 2011
Primary endpoint
31 May 2012
30 June 2012

Quick facts

Lead sponsorZS Pharma, Inc.
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingquadruple
Primary purposesupportive care
Enrollment90
Start date30 November 2011
Primary completion31 May 2012
Estimated completion30 June 2012
Sites9 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

ZS Pharma, Inc. — full company profile →

Who can join

18 and older, any sex, with Hyperkalemia or Chronic Kidney Disease. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Difference in the Exponential Rate of Change in Serum Potassium (S-K) Levels Versus Placebo During the Initial 48 Hours of Study Drug Treatment Primary · 24 and 48 hours post first study drug dose

The rate of fall in S-K levels during the initial 48 hours of study drug treatment between the placebo treated subjects and the ZS treated subjects measured on a log scale

Day2/0 Hr ( 24 hours)
GroupValue95% CI
Placebo (Combined All Three Cohorts)0± NA
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily-0.00035± 0.001166
Sodium Zirconium Cyclosilicate 3 g Three Times Daily-0.00169± 0.000932
Sodium Zirconium Cyclosilicate 10 g Three Times Daily-0.000143± 0.000932
Day 3/0 Hr (48 hours)
GroupValue95% CI
Placebo (Combined All Three Cohorts)0± NA
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily-0.00045± 0.000555
Sodium Zirconium Cyclosilicate 3 g Three Times Daily-0.00089± 0.000444
Sodium Zirconium Cyclosilicate 10 g Three Times Daily-0.00256± 0.000444
Serum Potassium (S-K) at Individual Time Points. Secondary · First 48 hours of study

Serum potassium (S-K) at individual time points through Study day 3/0hour.

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)5.14± 0.358
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily5.22± 0.264
Sodium Zirconium Cyclosilicate 3 g Three Times Daily5.02± 0.322
Sodium Zirconium Cyclosilicate 10 g Three Times Daily5.05± 0.359
Day 1/4Hr Post 1st Dose
GroupValue95% CI
Placebo (Combined All Three Cohorts)4.97± 0.564
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily5.06± 0.417
Sodium Zirconium Cyclosilicate 3 g Three Times Daily4.93± 0.518
Sodium Zirconium Cyclosilicate 10 g Three Times Daily4.80± 0.466
Day 1/4Hr Post 2nd Dose
GroupValue95% CI
Placebo (Combined All Three Cohorts)4.91± 0.465
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily5.14± 0.609
Sodium Zirconium Cyclosilicate 3 g Three Times Daily4.80± 0.543
Sodium Zirconium Cyclosilicate 10 g Three Times Daily4.68± 0.420
Day 1/4Hr Post 3rd Dose
GroupValue95% CI
Placebo (Combined All Three Cohorts)4.82± 0.558
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily4.91± 0.368
Sodium Zirconium Cyclosilicate 3 g Three Times Daily4.68± 0.577
Sodium Zirconium Cyclosilicate 10 g Three Times Daily4.50± 0.397
Day 2/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)4.97± 0.521
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily4.90± 0.447
Sodium Zirconium Cyclosilicate 3 g Three Times Daily4.66± 0.434
Sodium Zirconium Cyclosilicate 10 g Three Times Daily4.73± 0.463
Day 2/4Hr Post 1st Dose
GroupValue95% CI
Placebo (Combined All Three Cohorts)5.03± 0.441
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily4.97± 0.363
Sodium Zirconium Cyclosilicate 3 g Three Times Daily4.81± 0.601
Sodium Zirconium Cyclosilicate 10 g Three Times Daily4.53± 0.411
Day 2/4Hr Post 2nd Dose
GroupValue95% CI
Placebo (Combined All Three Cohorts)5.02± 0.426
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily5.04± 0.417
Sodium Zirconium Cyclosilicate 3 g Three Times Daily4.72± 0.604
Sodium Zirconium Cyclosilicate 10 g Three Times Daily4.43± 0.460
Day 2/4Hr Post 3rd Dose
GroupValue95% CI
Placebo (Combined All Three Cohorts)4.87± 0.486
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily4.83± 0.526
Sodium Zirconium Cyclosilicate 3 g Three Times Daily4.60± 0.566
Sodium Zirconium Cyclosilicate 10 g Three Times Daily4.13± 0.388
Time Specific S-K Levels to Normalization Secondary · 48 and 72 hours post first study drug dose

Percent of subjects achieving S-K normalization (\<=as defined by S-K levels of 3.5 to 4.9 mmol/L) from baseline at Study Days 2 and 3 at 0 hr.

Day2/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)90
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily75
Sodium Zirconium Cyclosilicate 3 g Three Times Daily95.8
Sodium Zirconium Cyclosilicate 10 g Three Times Daily100
Day 3/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)90
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily100
Sodium Zirconium Cyclosilicate 3 g Three Times Daily95.8
Sodium Zirconium Cyclosilicate 10 g Three Times Daily100
Time Specific Decreases in S-K Levels of > = 0.5 mmol/L Secondary · 24 and 48 hours post first study drug dose

Percentage of participants achieving a 0.5mmol/L drop from baseline at Study Days 2 and 3 at 0 hr.

Day 2/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)16.7
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily33.3
Sodium Zirconium Cyclosilicate 3 g Three Times Daily37.5
Sodium Zirconium Cyclosilicate 10 g Three Times Daily33.3
Day 3/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)26.7
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily41.7
Sodium Zirconium Cyclosilicate 3 g Three Times Daily41.7
Sodium Zirconium Cyclosilicate 10 g Three Times Daily62.5
Percentage of Participants With Normal S-K Levels at End of Study Day 2 Secondary · 48 hours post first study drug dose

Percentage (%) of subjects who achieve S-K normalization at end of Study Day 2

GroupValue95% CI
Placebo (Combined All Three Cohorts)90
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily75
Sodium Zirconium Cyclosilicate 3 g Three Times Daily95.8
Sodium Zirconium Cyclosilicate 10 g Three Times Daily100
Urine Sodium Excretion Secondary · 24 and 48 hours post first study drug dose

Urine sodium excretion compared between the combined placebo-treated controls and the ZS-treated subjects (measured throughout two 24-hour periods on Study Days 1 and 2).

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)91.5± 30.31
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily73.5± 29.79
Sodium Zirconium Cyclosilicate 3 g Three Times Daily81.7± 33.16
Sodium Zirconium Cyclosilicate 10 g Three Times Daily74.5± 34.20
Day 1/0-24Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)74.4± 24.8
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily66.7± 18.49
Sodium Zirconium Cyclosilicate 3 g Three Times Daily66.8± 26.26
Sodium Zirconium Cyclosilicate 10 g Three Times Daily67.1± 29.19
Day 2/24-48Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)80.1± 28.21
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily67.5± 26.63
Sodium Zirconium Cyclosilicate 3 g Three Times Daily71.6± 31.61
Sodium Zirconium Cyclosilicate 10 g Three Times Daily75.8± 35.74
Urine Potassium Excretion Secondary · 24 and 48 hours post study drug dose

Urine potassium excretion compared between the combined placebo-treated controls and the ZS-treated subjects (measured throughout two 24-hour periods on Study Days 1 and 2).

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)36.6± 12.47
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily32.2± 2.12
Sodium Zirconium Cyclosilicate 3 g Three Times Daily38.3± 11.82
Sodium Zirconium Cyclosilicate 10 g Three Times Daily30.3± 15.81
Day1/0-24Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)28.7± 6.41
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily32.0± 3.16
Sodium Zirconium Cyclosilicate 3 g Three Times Daily30.6± 5.96
Sodium Zirconium Cyclosilicate 10 g Three Times Daily19.7± 9.69
Day2/24-48Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)29.2± 6.42
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily31.0± 0.00
Sodium Zirconium Cyclosilicate 3 g Three Times Daily30.5± 6.51
Sodium Zirconium Cyclosilicate 10 g Three Times Daily16.9± 8.80
Urea Nitrogen Excretion Secondary · 24 and 48 hours post study drug dose

Urea nitrogen excretion compared between the combined placebo-treated controls and the ZS-treated subjects (measured throughout two 24-hour periods on Study Days 1 and 2).

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)525.0± 219.79
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily430.2± 162.92
Sodium Zirconium Cyclosilicate 3 g Three Times Daily481.0± 198.92
Sodium Zirconium Cyclosilicate 10 g Three Times Daily424.7± 171.88
Day1/ 0-24 HR
GroupValue95% CI
Placebo (Combined All Three Cohorts)389.2± 179.91
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily401.8± 265.74
Sodium Zirconium Cyclosilicate 3 g Three Times Daily414.1± 177.54
Sodium Zirconium Cyclosilicate 10 g Three Times Daily368.5± 147.37
Day2/ 24-48 HR
GroupValue95% CI
Placebo (Combined All Three Cohorts)460.9± 175.09
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily337.6± 115.06
Sodium Zirconium Cyclosilicate 3 g Three Times Daily477.0± 157.04
Sodium Zirconium Cyclosilicate 10 g Three Times Daily416.6± 219.56
Blood Urea Nitrogen Secondary · 24 and 48 hours post study drug dose

Blood urea nitrogen compared between the combined placebo-treated controls and the ZS-treated subjects (measured 24 \& 48 hours post dose on Study Days 2 and 3).

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)24.50± 7.481
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily23.52± 8.217
Sodium Zirconium Cyclosilicate 3 g Three Times Daily25.16± 8.065
Sodium Zirconium Cyclosilicate 10 g Three Times Daily30.37± 8.092
Day 2/)0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)24.05± 7.626
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily23.63± 7.241
Sodium Zirconium Cyclosilicate 3 g Three Times Daily23.98± 7.619
Sodium Zirconium Cyclosilicate 10 g Three Times Daily27.53± 7.602
Day 3/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)24.50± 7.284
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily23.33± 7.895
Sodium Zirconium Cyclosilicate 3 g Three Times Daily24.04± 7.661
Sodium Zirconium Cyclosilicate 10 g Three Times Daily25.60± 7.942
Serum Magnesium (S-Mg) Levels Secondary · 24 and 48 hours post study drug dose

Serum magnesium compared between the combined placebo-treated controls and the ZS-treated subjects (measured at 24 \& 48 hours post dose on Study Days 2 and 3).

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)1.93± 0.258
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily1.95± 0.327
Sodium Zirconium Cyclosilicate 3 g Three Times Daily1.93± 0.143
Sodium Zirconium Cyclosilicate 10 g Three Times Daily1.85± 0.235
Day 2/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)1.92± 0.197
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily1.93± 0.271
Sodium Zirconium Cyclosilicate 3 g Three Times Daily1.94± 0.182
Sodium Zirconium Cyclosilicate 10 g Three Times Daily1.81± 0.225
Day 3/0Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)1.90± 0.204
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily1.89± 0.257
Sodium Zirconium Cyclosilicate 3 g Three Times Daily1.94± 0.179
Sodium Zirconium Cyclosilicate 10 g Three Times Daily1.83± 0.218
Serum Calcium (S-Ca) Levels Secondary · 24 and 48 hours post study drug dose

Serum calcium compared between the combined placebo-treated controls and the ZS-treated subjects (measured at 24 \& 48 hours post dose on Study Days 2 and 3).

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)9.46± 0.595
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily9.37± 0.341
Sodium Zirconium Cyclosilicate 3 g Three Times Daily9.48± 0.337
Sodium Zirconium Cyclosilicate 10 g Three Times Daily9.50± 0.469
Day 2/0 Hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)9.39± 0.439
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily9.36± 0.507
Sodium Zirconium Cyclosilicate 3 g Three Times Daily9.33± 0.388
Sodium Zirconium Cyclosilicate 10 g Three Times Daily9.22± 0.466
Day 3/0 hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)9.51± 0.544
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily9.33± 0.360
Sodium Zirconium Cyclosilicate 3 g Three Times Daily9.30± 0.397
Sodium Zirconium Cyclosilicate 10 g Three Times Daily9.05± 0.425
Serum Sodium (S-Na) Levels Secondary · 24 and 48 hours post study drug dose

Serum sodium compared between the combined placebo-treated controls and the ZS-treated subjects (measured at 24 \& 48 hours post dose on Study Days 2 and 3).

Baseline
GroupValue95% CI
Placebo (Combined All Three Cohorts)139.4± 2.84
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily139.1± 3.65
Sodium Zirconium Cyclosilicate 3 g Three Times Daily140.0± 3.09
Sodium Zirconium Cyclosilicate 10 g Three Times Daily137.7± 3.45
Day 2/0 hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)140.1± 3.24
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily138.8± 2.04
Sodium Zirconium Cyclosilicate 3 g Three Times Daily140.1± 3.83
Sodium Zirconium Cyclosilicate 10 g Three Times Daily138.6± 3.37
Day 3/0 hr
GroupValue95% CI
Placebo (Combined All Three Cohorts)140.0± 3.36
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily138.5± 2.28
Sodium Zirconium Cyclosilicate 3 g Three Times Daily140.0± 3.91
Sodium Zirconium Cyclosilicate 10 g Three Times Daily139.6± 3.50

Adverse events — posted to ClinicalTrials.gov

Time frame: Study Days 1 to 7. Reporting threshold: 3%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Placebo
Serious: 0/30 (0%)
Deaths: 0/30
Sodium Zirconium Cyclosilicate (ZS) 0.3 g Three Times Daily
Serious: 0/12 (0%)
Deaths: 0/12
Sodium Zirconium Cyclosilicate 3 g Three Times Daily
Serious: 0/24 (0%)
Deaths: 0/24
Sodium Zirconium Cyclosilicate 10 g Three Times Daily
Serious: 0/24 (0%)
Deaths: 0/24
Other adverse events (13 terms — click to expand)

ReactionSystemPlaceboSodium Zirconium Cyclosili…Sodium Zirconium Cyclosili…Sodium Zirconium Cyclosili…
VomitingGastrointestinal disorders
NauseaGastrointestinal disorders
Urinary tract infectionInfections and infestations
HypertensionVascular disorders
ConstipationGastrointestinal disorders
DiarrheaGastrointestinal disorders
DyspepsiaGastrointestinal disorders
Aspartate aminotransferae increasedInvestigations
Pain in extremityMusculoskeletal and connective tissue disorders
Abdominal tendernessGastrointestinal disorders
Abdominal painGastrointestinal disorders
AnaemiaBlood and lymphatic system disorders
HeadacheNervous system disorders

Data from ClinicalTrials.gov NCT01493024 adverse events section.

Sponsor's own description

It is hypothesized that zirconium silicate is safe and well tolerated and more effective than placebo (alternative hypothesis) in lowering serum potassium levels in subjects with serum potassium between 5 - 6.0 mmol/l versus no difference between zirconium silicate and placebo (null hypothesis). It is hypothesized that zirconium silicate even up to the top dose of 10g three times a day is well tolerated.

Publications & conference data

4 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Characterization of structure and function of ZS-9, a K+ selective ion trap.
    Stavros F, Yang A, Leon A, Nuttall M, et al · · 2014 · cited 131× · PMID 25531770 · DOI 10.1371/journal.pone.0114686
  2. A phase 2 study on the treatment of hyperkalemia in patients with chronic kidney disease suggests that the selective potassium trap, ZS-9, is safe and efficient.
    Ash SR, Singh B, Lavin PT, Stavros F, et al · · 2015 · cited 120× · PMID 25651363 · DOI 10.1038/ki.2014.382
  3. Potassium binders for chronic hyperkalaemia in people with chronic kidney disease.
    Natale P, Palmer SC, Ruospo M, Saglimbene VM, et al · · 2020 · cited 30× · PMID 32588430 · DOI 10.1002/14651858.cd013165.pub2
  4. Patient and Public Involvement (PPI) in outcome selection in breast cancer and nephrology trials.
    Buckley C, Treweek S, Laidlaw L, Shiely F. · · 2023 · cited 2× · PMID 36747232 · DOI 10.1186/s13063-022-06980-9

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Other recruiting trials for Hyperkalemia

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Data sources for this page

Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT01493024.

Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing