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.
- 1The First People's Hospital of Lin'an District, Hangzhou, Zhejiang, China.
- 2The First People's Hospital of Lin'an District, Hangzhou, Zhejiang, China. [email protected].
- 3The First People's Hospital of Lin'an District, Hangzhou, Zhejiang, China. [email protected].
Abstract
Background
A 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
This 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
The 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
Individualized 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
Chinese Clinical Trial Registry, ChiCTR2600119050. Registered on 14 February 2026; retrospectively registered.
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BibTeX
@article{wang2026sustained,
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.}},
author = {Haiming Wang and Wei Zhou and Yan Jiang},
journal = {BMC nephrology},
year = {2026},
month = oct,
doi = {10.1186/s12882-026-05446-3},
url = {https://europepmc.org/article/MED/42875751},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Haiming Wang
AU - Wei Zhou
AU - Yan Jiang
PY - 2026
DA - 2026/10/12
JO - BMC nephrology
DO - 10.1186/s12882-026-05446-3
UR - https://europepmc.org/article/MED/42875751
AB - Background A 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 This 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 The 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 Individualized 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 Chinese Clinical Trial Registry, ChiCTR2600119050. Registered on 14 February 2026; retrospectively registered.
SN - 1471-2369
ER -