The optimal approach towards managing serum potassium and hemodialysate potassium concentrations is uncertain. To study this, adults receiving hemodialysis for three months or more with hyperkalemia (pre-dialysis serum potassium (sK+) 5.1–6.5 mEq/l) had cardiac monitors implanted and were randomized to either eight weeks of 2.0 potassium/2.5 calcium mEq/l dialysate without sodium zirconium cyclosilicate (SZC) (2.0 potassium/noSZC) or 3.0 potassium/2.5 calcium mEq/l dialysate combined with SZC (3.0 potassium/SZC) on non-dialysis days to maintain pre-dialysis sK+ 4.0–5.5 mEq/l, followed by treatment crossover for another eight weeks. The primary outcome was the rate of adjudicated atrial fibrillation (AF) episodes of 2 minutes or more duration. Secondary outcomes included clinically significant arrhythmias (bradycardia, ventricular tachycardia, and/or asystole) and the proportion of sK+ measurements within an optimal window of 4.0–5.5 mEq/l. Among 88 participants (mean age: 57.1 years; 51% male; mean pre-dialysis sK+: 5.5 mmol/l) with 25.5 person-years of follow-up, 296 AF episodes were detected in nine patients. The unadjusted AF rate was lower with 3.0 potassium/SZC versus 2.0 potassium/noSZC; 9.7 vs. 13.4/person-year (modeled rate ratio 0.52; 95% confidence interval: 0.41; 0.65). Clinically significant arrhythmias were reduced with 3.0 potassium/SZC vs. 2.0 potassium/noSZC 6.8 vs. 10.2/person-year modeled rate ratio 0.47: 0.38;0.58). Fewer sK+ measurements outside the optimal window occurred with 3.0 potassium/SZC (modeled odds ratio: 0.27:0.12, 0.35). Hypokalemia was less frequent (33 vs. 58 patients) with 3.0 potassium/SZC compared with 2.0 potassium/noSZC. Thus, in patients with hyperkalemia on maintenance hemodialysis, a combination of potassium 3.0 mEq/l and SZC on non-hemodialysis days reduced the rates of AF, other clinically significant arrhythmias, and post-dialysis hypokalemia compared with potassium 2.0/noSZC.

中文翻译：

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环硅酸锆钠透析液钾浓度为 3.0 mmol/l 与单独使用透析液钾浓度 2.0 mmol/l 对高钾血症血液透析患者心律失常发生率的影响


管理血清钾和血液透析液钾浓度的最佳方法尚不确定。为了研究这一点，接受血液透析三个月或更长时间的高钾血症（透析前血清钾 （sK+） 5.1-6.5 mEq/l）的成年人植入了心脏监护仪，并被随机分配到 8 周的 2.0 钾/2.5 mEq/l 透析液中，不含环硅酸锆钠 （SZC）（2.0 钾/noSZC）或 3.0 钾/2.5 mEq/l 透析液联合 SZC（3.0 钾/SZC），以维持透析前 sK+ 4.0-5.5 mEq/l， 随后再进行 8 周的治疗交叉。主要结局是经判定的心房颤动 （AF） 发作持续时间为 2 分钟或更长时间的发生率。次要结局包括有临床意义的心律失常（心动过缓、室性心动过速和/或心脏停搏）和 4.0-5.5 mEq/l 最佳窗口内 sK+ 测量值的比例。在 88 名参与者 （平均年龄： 57.1 岁;51% 为男性;平均透析前 sK+： 5.5 mmol/l） 和 25.5 人年的随访中，在 9 名患者中检测到 296 次 AF 发作。3.0 钾/SZC 的未调整 AF 率低于 2.0 钾/noSZC;9.7 vs. 13.4/人年（模型比率 0.52;95% 置信区间：0.41;0.65）。钾/SZC 为 3.0 比 2.0 钾/noSZC 时，临床显着心律失常减少 6.8 vs. 10.2/人年，建模率比为 0.47：0.38;0.58）. 3.0 钾/SZC 时，最佳窗口外的 sK+ 测量值较少 （建模比值比： 0.27：0.12， 0.35）。与 2.0 钾/noSZC 相比，3.0 钾/SZC 的低钾血症发生率较低 （33 例对 58 例患者）。因此，在维持性血液透析的高钾血症患者中，钾 3.与钾 2.0/noSZC 相比，非血液透析日的 0 mEq/l 和 SZC 降低了 AF 、其他临床显着心律失常和透析后低钾血症的发生率。