Abstract
Cardiac arrythmias are common in patients undergoing maintenance hemodialysis (HD). In this issue of the journal, Charytan et al showed that, in HD patients with hyperkalemia (5.1 - 6.5 mEq/l), a dialysate concentration of 3 mEq/l combined with sodium zirconium cyclosilicate (SZC) on dialysis-free days is associated with a less rate of atrial fibrillation compared to a dialysate concentration of 2 mEq/l over 8 weeks. Despite the obvious limitations such as the small sample size, short treatment period and the absence of information on longer-term impact regarding patient important outcomes such as sudden death, this well-conceived pilot study provides impetus for larger prospective trials to test whether this personalized approach reduces major cardiovascular events and mortality.
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