ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO1051

Risk of Hypokalemia in Hyperkalemic Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Fishbane, Steven, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Ford, Martin L., King's College Hospital Trust, London, United Kingdom
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Japan
  • Mccafferty, Kieran, Barts Health NHS Trust, London, United Kingdom
  • Rastogi, Anjay, David Geffen School of Medicine, Los Angeles, California, United States
  • Spinowitz, Bruce S., NewYork-Presbyterian Queens, Queens, New York, United States
  • Staroselskiy, Konstantin, B. Braun Avitum Russland Clinics, St Petersburg, Russian Federation
  • Vishnevskiy, Konstantin, First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation
  • Lisovskaja, Vera, AstraZeneca BioPharmaceuticals Research and Development, Gothenburg, Sweden
  • Al-shurbaji, Ayman, AstraZeneca BioPharmaceuticals Research and Development, Gothenburg, Sweden
  • Guzman, Nicolas Jose, AstraZeneca BioPharmaceuticals Research and Development, Gaithersburg, Maryland, United States
  • Bhandari, Sunil, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom

Combined pre- and post-dialysis hypokalemia is associated with increased mortality risk. The Phase 3b DIALIZE study (NCT03303521) showed that sodium zirconium cyclosilicate (SZC) reduces pre-dialysis serum potassium (sK+) and is well tolerated in hemodialysis patients (pts) with hyperkalemia. In this post-hoc safety analysis of DIALIZE, we report hypokalemia events in the SZC and placebo (PBO) arms.


In DIALIZE, 196 pts were randomized blindly 1:1 to receive PBO (n=99) or SZC (n=97) 5 g starting dose once daily on non-dialysis days (4 days/week [wk]) for 8 wks, comprising a 4-wk SZC or PBO dose-titration phase (max 15 g) to achieve target pre-dialysis sK+ 4.0–5.0 mmol/L, and a 4-wk stable-dose evaluation phase. In this post-hoc analysis, the proportions of pts with hypokalemia (sK+ <3.5 mmol/L) pre-dialysis, post-dialysis, and combined pre- and post-dialysis at the same visit were tabulated by visit. Pts’ current pre-dialysis sK+ stratified by post-dialysis sK+ (≥3.5 vs <3.5 mmol/L) at the previous visit was also assessed.


The frequency of pre-dialysis hypokalemia was comparable between SZC and PBO, with 5 pts in each arm accounting for 7 and 5 events, respectively. The proportion of pts with post-dialysis hypokalemia at each visit was greater with SZC than PBO. For all but 2 SZC pts with post-dialysis hypokalemia, pre-dialysis sK+ returned to ≥3.5 mmol/L at the next visit (Figure). In each arm, 1 pt had combined pre- and post-dialysis hypokalemia.


Despite the efficacy of SZC in lowering pre-dialysis sK+, SZC was not associated with a clinically significant increase in the frequency of pre-dialysis hypokalemia. Treatment with SZC vs PBO did not increase the frequency of combined pre- and post-dialysis hypokalemia which is associated with increased mortality risk.


  • Commercial Support