Sustained potassium control and recurrent hyperkalemia during individualized potassium-guided sodium zirconium cyclosilicate titration in maintenance hemodialysis: a post hoc analysis of a randomized trial.
Haiming Wang, Wei Zhou, Yan Jiang
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In 30 seconds
This exploratory post hoc analysis of a single-centre, open-label randomised trial assessed sustained potassium control with individualized potassium-guided sodium zirconium cyclosilicate (SZC) in 116 maintenance haemodialysis patients with chronic hyperkalemia. During months 3–6, 25/58 (43.1%) SZC-treated participants met the prespecified sustained response criterion, compared with 8/58 (13.8%) controls (adjusted risk ratio 3.02, 95% confidence interval [CI] 1.49-6.14). SZC was also associated with fewer recurrent potassium elevations. The analysis evaluated biochemical measurements, not clinical outcomes, so it does not establish clinical benefit.
Key findings
- Sustained potassium response within 4.0-5.0 mmol/L occurred in 25/58 (43.1%) with SZC and 8/58 (13.8%) in controls (aRR 3.02, 95% CI 1.49-6.14).
- Sustained response within 4.0-5.5 mmol/L occurred in 38/58 (65.5%) and 22/58 (37.9%), respectively (aRR 1.74, 95% CI 1.19-2.54).
- At least two scheduled potassium values ≥ 5.5 mmol/L occurred in 11/58 (19.0%) with SZC versus 36/58 (62.1%) in controls (aRR 0.31, 95% CI 0.18-0.55).
- The adjusted incidence rate ratio for visits with potassium ≥ 5.5 mmol/L was 0.36 (95% CI 0.24-0.54).
Why it matters
A single predialysis potassium measurement may not capture whether control is maintained or hyperkalemia recurs over time. These findings suggest individualized SZC titration can improve sustained biochemical control across scheduled monthly measurements in haemodialysis patients. However, because clinical outcomes were not evaluated, the biochemical differences cannot be taken as evidence that treatment reduces symptoms, complications, or other patient-important outcomes.
What to keep in mind
This was an exploratory post hoc analysis of a single-centre, open-label trial. The outcome was based on scheduled biochemical measurements, and clinical outcomes were not evaluated.