Treatment with the potassium binder sodium zirconium cyclosilicate (SZC) does not appear to increase the frequency of dangerous hypokalemia, according to results from a short-term study presented at Kidney Week 2020 Reimagined, the virtual conference sponsored by the American Society of Nephrology.

In DIALIZE, 196 patients with hyperkalemia receiving thrice-weekly hemodialysis were randomly assigned to receive SZC (5 to 15 g once daily on nondialysis days) or placebo for 8 weeks to reduce and maintain serum potassium within a target range of 4.0 to 5.0 mmol/L. This post-hoc safety analysis found that pre-dialysis hypokalemia of less than 3.5 mmol/L occurred with similar frequency in the SZC and placebo groups with 7 and 5 events, respectively, occurring in 5 patients in each group, Steven Fishbane, MD, of Hofstra/Northwell Health in Great Neck, New York, and colleagues reported. Post-dialysis hypokalemia was more frequent with SZC than placebo at each visit, and all but 2 SZC patients had their pre-dialysis serum potassium levels return to 3.5 mmol/L or greater by the next visit. Only 1 patient in each study arm experienced 1 instance of combined pre- and post-dialysis hypokalemia during a single visit. SZC and placebo patients with hypokalemia displayed comparable serum potassium levels.

“SZC was not associated with a clinically significant increase in the frequency of pre-dialysis hypokalemia,” Dr Fishbane’s team concluded. In addition, “treatment with SZC versus [placebo] did not increase the frequency of combined pre- and post-dialysis hypokalemia, which is associated with increased mortality risk.”

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Disclosure: This clinical trial was supported by AstraZeneca. Please see the original reference for a full list of authors’ disclosures.


Fishbane S, Ford ML, Fukagawa M, et al. Risk of hypokalemia in hyperkalemic hemodialysis patients. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO1051.