Potassium binder may ease the burden of dietary potassium restriction in people on dialysis
· Medical Xpressby American Society of Nephrology
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Dietary potassium restriction is important for managing hyperkalemia, or high blood potassium levels, in individuals on maintenance hemodialysis, but it imposes a substantial day-to-day burden. Results from a recent clinical trial indicate that adding the potassium binder sodium zirconium cyclosilicate (SZC) may help. The findings will be presented at ASN Kidney Week 2026, Oct. 22–25.
In the multicenter, randomized, open-label, parallel-group trial, outpatients receiving thrice-weekly maintenance hemodialysis with pre-dialysis serum potassium of 5.5 to <6.5 mEq/L were assigned to SZC plus standardized nutritional counseling or nutritional counseling alone for eight weeks.
In the main analysis including 183 patients, those who received SZC plus standardized nutrition counseling had a greater improvement in quality of life related to dietary potassium restriction than those who received nutrition counseling alone. SZC also lowered pre-dialysis serum potassium more effectively. No patient in the SZC group needed rescue treatment during the eight-week study, compared with 25 of 92 patients in the control group.
In exploratory analyses, the investigators also saw an increase in fruit intake without an increase in total dietary potassium intake, as well as improvements in several areas of kidney disease-related quality of life. There were no serious treatment-related adverse events or deaths.
"SZC may provide an important patient-centered benefit beyond lowering serum potassium. When added to standardized nutritional counseling and regular potassium monitoring, SZC reduced the day-to-day burden of dietary potassium restriction while also providing better potassium control," said corresponding author Hiromichi Wakui, M.D., Ph.D., of Yokohama City University Graduate School of Medicine. "Hyperkalemia treatment should be judged not only by whether the potassium level falls, but also by whether treatment makes daily life less burdensome for patients."
The investigators stressed that individualized dietary assessment, regular potassium monitoring and attention to overall nutritional quality remain essential. When dietary restriction alone places a substantial burden on patients, potassium-binding therapy may support a safer and more patient-centered management strategy.
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