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The REALIZE-K trial evaluated the efficacy of sodium zirconium cyclosilicate (SZC) in enabling the optimization of mineralocorticoid receptor antagonist (MRA) therapy, specifically spironolactone, in patients with heart failure with reduced ejection fraction (HFrEF) who had hyperkalemia or were at high risk for it

Findings suggest that SNAC technology enables oral absorption that is comparable to intramuscular injection

Taking the medication at a consistent time and following the specific administration instructions for each agent optimizes tolerability

Goal: raise muscle carnitine and alter substrate use Dose and timing: ~2 grams per day taken with a carbohydraterich meal or snack to create a modest insulin response