- Design
- Post hoc analysis of a single-centre, open-label randomised trial
- Population
- 116 maintenance haemodialysis patients with chronic hyperkalaemia
- Primary outcome
- Sustained potassium control in months 3-6
- Effect
- 43.1% vs 13.8%; aRR 3.02 (95% CI 1.49-6.14)
This post hoc analysis used a single-centre, open-label randomised trial of 116 haemodialysis patients with chronic hyperkalaemia. Half received sodium zirconium cyclosilicate on non-dialysis days, titrated to potassium; half did not. Published in BMC Nephrology on 12 October 2026.
Sustained control, at least three of four monthly post-weekend potassium values between 4.0 and 5.0 mmol/L with no emergency dialysis, was reached by 43% with the binder and 14% without (adjusted RR 3.02, 95% CI 1.49 to 6.14). Two or more readings of 5.5 mmol/L or above occurred in 19% versus 62%, and hyperkalaemic visits fell by about two-thirds.
A single average potassium hides patients who swing repeatedly above the danger threshold after the long interdialytic gap. Tracking sustained control is a better reflection of risk.
The authors stress that only biochemistry was measured, not arrhythmia, admissions or death. The trial was single-centre, open-label and retrospectively registered.
- Track post-weekend potassium over several months, not a single average
- Consider a potassium binder on non-dialysis days for patients with repeated pre-dialysis hyperkalaemia
- Titrate the binder dose to measured potassium rather than using a fixed dose
- Review diet, constipation and potassium-raising drugs before adding a binder
- Watch for oedema and fluid gain, since the binder contains sodium
Why it matters
Patients who repeatedly cross the hyperkalaemia threshold are missed when potassium is judged by averages.
Don't overread it
Biochemical control only; the authors caution that it is not evidence of clinical benefit.
The statistics, in plain English
An adjusted RR of 3.02 means sustained control was about three times as likely with the binder. The wide confidence interval (1.49 to 6.14) reflects a small, single-centre sample.
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