Where next for potassium binders in hemodialysis?

Patients on hemodialysis frequently experience hyperkalemia, a condition linked to arrhythmia and mortality. The DIALIZE-Outcomes trial was designed to investigate whether the oral potassium binder, sodium zirconium cyclosilicate, could reduce cardiovascular events. The trial was terminated early because of low event accrual and high rates of medication discontinuation. From the available data, no difference in outcomes was observed, despite better potassium control. We discuss the strengths and limitations of the trial and highlight considerations for future studies.