Effects of dialysate potassium concentration of 3.0 mmol/l with sodium zirconium cyclosilicate on dialysis-free days versus dialysate potassium concentration of 2.0 mmol/l alone on rates of cardiac arrhythmias in hemodialysis patients with hyperkalemia.

To study this, adults receiving hemodialysis for three months or more with hyperkalemia (pre-dialysis sK+ 5.1-6.5 mmol/l) had cardiac monitors implanted and were randomized to either eight weeks of 2.0 mmol/l potassium/1.25 mmol/l calcium dialysate without sodium zirconium cyclosilicate (SZC) (2.0 potassium/noSZC) or 3.0 mmol/l potassium/1.25 mmol/l calcium dialysate combined with SZC (3.0 potassium/SZC) on non-dialysis days to maintain pre-dialysis sK+ 4.0-5.5 mmol/l, followed by treatment crossover for another eight weeks.

为了研究这个问题，对于接受血液透析三个月或更长时间且伴有高钾血症（透析前sK+ 5.1-6.5 mmol/l）的成年人，植入了心脏监测器，并随机分配到两组中的一组，接受八周的2.0 mmol/l钾/1.25 mmol/l钙透析液，不使用锆硅酸钠（SZC）（2.0钾/无SZC），或者在非透析日接受3.0 mmol/l钾/1.25 mmol/l钙透析液，结合使用SZC（3.0钾/SZC），以维持透析前sK+ 4.0-5.5 mmol/l，随后进行为期八周的治疗交叉。

The primary outcome was the rate of adjudicated atrial fibrillation (AF) episodes of at least 2 minutes duration.

主要结果是至少持续2分钟的经判定心房颤动(AF)发作率。

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 mmol/l.

次要结果包括临床上有意义的心律失常（心动过缓、室性心动过速和/或无脉搏）以及sK+测量值在4.0-5.5 mmol/l的最优范围内的比例。

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.

在88名参与者（平均年龄：57.1岁；51%为男性；平均透析前血钾水平为5.5 mmol/l）中，随访25.5人年期间，共检测到9名患者的296次房颤发作。

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 interval0.41-0.65).

未经调整的房颤发生率在3.0钾/SZC组低于2.0钾/noSZC组；分别为9.7次/人年和13.4次/人年（模型化率比为0.52；95%置信区间为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).

与2.0钾/无SZC相比，3.0钾/SZC显著降低了临床重要性的心律失常发生率（6.8 vs. 10.2/人年，建模率比为0.47；95%置信区间为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).

使用3.0钾/SZC时，超出最佳范围的血钾测量次数减少（建模比值比为0.27；95%置信区间为0.12-0.35）。

Hypokalemia was less frequent (33 vs. 58 patients) with 3.0 potassium/SZC compared with 2.0 potassium/noSZC.

在使用3.0 mmol/l透析液钾和SZC的患者中，低钾血症的发生率较低（33例对比58例），与使用2.0 mmol/l透析液钾且不使用SZC的患者相比。

Thus, in patients with hyperkalemia on maintenance hemodialysis, a combination of hemodialysate potassium 3.0 mmol/l and SZC on non-hemodialysis days reduced the rates of AF, other clinically significant arrhythmias, and post-dialysis hypokalemia compared with hemodialysate potassium 2.0/noSZC.

因此，在维持性血液透析的高钾血症患者中，将血液透析液钾浓度维持在3.0 mmol/l，并在非透析日使用SZC，与透析液钾浓度为2.0 mmol/l且不使用SZC相比，降低了房颤、其他临床显著性心律失常以及透析后低钾血症的发生率。