Observational data have shown that both lower and higher serum potassium are associated with mortality in hemodialysis patients. The standard response to hyperkalemia is to lower the dialysate potassium. Unfortunately, low dialysate potassium is associated with increased mortality.
In my DreamRCT hyperkalemic dialysis patients would be randomized to one of the new potassium binders (ZS-9 and patiromer) or placebo.
The primary outcome is sudden cardiac death.
Secondary outcomes would include hospitalization for hyperkalemia, hospitalization for arrhythmia, new arrhythmia diagnosis, and questionnaire defined potassium intake.