{
  "abstract": "Background\n\nA mean predialysis potassium value at a single visit does not show whether the same patient remains controlled across consecutive months or repeatedly crosses hyperkalemic thresholds. We evaluated sustained patient-level potassium control and recurrent hyperkalemia during individualized potassium-guided sodium zirconium cyclosilicate (SZC) therapy on non-dialysis days.Methods\n\nThis exploratory post hoc analysis used data from a previously reported single-center, open-label randomized trial of 116 patients with chronic hyperkalemia (58 per group). The primary outcome was sustained response during months 3-6, which required all four scheduled predialysis potassium measurements after the long interdialytic interval to be available, at least three of the four values to be within 4.0-5.0 mmol/L, and no unplanned hemodialysis triggered by potassium ≥ 6.5 mmol/L during the evaluation period. Missing measurements were classified as nonresponse. Adjusted risk ratios (aRRs) were estimated using modified Poisson regression with robust standard errors.Results\n\nThe primary outcome occurred in 25/58 (43.1%) SZC-treated participants and 8/58 (13.8%) controls (aRR 3.02, 95% confidence interval [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%) and 36/58 (62.1%) (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). Complete-case and conservative extreme-case missing-data analyses were directionally consistent with the main analysis.Conclusions\n\nIndividualized potassium-guided SZC therapy was associated with a higher probability of meeting the sustained biochemical potassium-control criterion at scheduled monthly measurements and with fewer recurrent biochemical hyperkalemic excursions. Clinical outcomes were not evaluated in the present analysis; therefore, the observed biochemical improvements should not be interpreted as evidence of clinical benefit.Trial registration\n\nChinese Clinical Trial Registry, ChiCTR2600119050. Registered on 14 February 2026; retrospectively registered.",
  "abstract_shown": true,
  "affiliations": [
    "The First People's Hospital of Lin'an District, Hangzhou, Zhejiang, China.",
    "The First People's Hospital of Lin'an District, Hangzhou, Zhejiang, China. 23620104@qq.com.",
    "The First People's Hospital of Lin'an District, Hangzhou, Zhejiang, China. jiangyan@hmc.edu.cn."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Haiming Wang"
    },
    {
      "affs": [
        1
      ],
      "name": "Wei Zhou"
    },
    {
      "affs": [
        2
      ],
      "name": "Yan Jiang",
      "orcid": "0009-0006-8798-7558"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cm4m182vbeega.bib",
  "cited_by": 0,
  "doi": "10.1186/s12882-026-05446-3",
  "fulltext_url": "https://europepmc.org/articles/PMC13670448",
  "id": "cm4m182vbeega",
  "issns": [
    "1471-2369"
  ],
  "landing_url": "https://europepmc.org/article/MED/42875751",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Potassium and Related Disorders"
    ]
  ],
  "openalex": "W7221521828",
  "pdf_url": "https://europepmc.org/articles/PMC13670448?pdf=render",
  "pmcid": "PMC13670448",
  "pmid": "42875751",
  "published": "2026-10-12",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/cm4m182vbeega.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:00Z",
      "native_id": "MED:42875751",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42875751"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Potassium and Related Disorders",
      "subfield": "general"
    }
  ],
  "title": "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.",
  "title_text": "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.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:00Z",
  "url": "https://research.draconitic.com/paper/cm4m182vbeega",
  "venue": "BMC nephrology",
  "versions": []
}