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Abstract: PO1165

Disease Course of Hyperkalemia in Patients on Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Spinowitz, Bruce S., New York Presbyterian Queens, Queens, New York, United States
  • Fishbane, Steven, Zucker School of Medicine at Hofstra/Northwell, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Japan
  • Ford, Martin L., King's College Hospital NHS Trust, London, United Kingdom
  • Guzman, Nicolas Jose, AstraZeneca BioPharmaceuticals Research and Development, Gaithersburg, Maryland, United States
  • Rastogi, Anjay, David Geffen School of Medicine, Los Angeles, California, United States

Hyperkalemia (HK) preceding hemodialysis (HD) is associated with increased risk of mortality and hospitalization. Longitudinal data on serum potassium (sK+) in this population is sparse. This post-hoc analysis of data from the placebo (PBO) arm of DIALIZE (NCT03303521) explored the course of HK in HD pts.


In DIALIZE, 196 pts were randomized 1:1 to PBO (n=99) or sodium zirconium cyclosilicate (SZC) (n=97) 5 g starting dose once daily on non-dialysis days for 8 weeks (8w), comprising a 4-week SZC dose-titration phase (max 15 g) to achieve target pre-dialysis sK+ 4.0–5.0 mmol/L, and a 4-week stable-dose evaluation phase. All pts received HD TIW and dietary counselling. Post-hoc analysis of PBO pts by baseline (BL) pre-dialysis sK+ included mean pre- and post-dialysis sK+ by visit, and proportions of pts who had mean pre-dialysis sK+ of 4.0–5.0 and 4.0–5.5 mmol/L by visit (including pts receiving rescue therapy).


Mean pre-dialysis sK+ after the long interdialytic interval was 5.9 mmol/L at BL (Day 1) and 5.7 mmol/L at end of treatment (EOT; Day 57) (Figure). Across all BL pt strata, mean pre-dialysis sK+ remained ≥5.0 mmol/L for all study visits (Figure). For pts with BL pre-dialysis sK+ <5.5, 5.5–<6.0, 6.0–<6.5, and ≥6.5 mmol/L, mean pre-dialysis sK+ at EOT was 5.4, 5.9, 5.6, and 5.9 mmol/L, respectively (Figure). Over 8w, only 7.0–23.1% and 31.1–60.6% of PBO pts had a pre-dialysis sK+ of 4.0–5.0 and 4.0–5.5 mmol/L, respectively, at any study visit. Mean post-dialysis sK+ was 3.9 mmol/L at BL and at EOT.


In pts receiving PBO and counselling following a HK event, mean sK+ remains high over 8w. Most pts remain hyperkalemic over this period and are therefore at continued risk of adverse outcomes.


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