Avoiding arrythmias by personalizing the dialysate concentration: a case for precision medicine in patients on dialysis

Kidney International, vol. 107, pp. 18–20

Abstract

Cardiac arrythmias are common in patients undergoing maintenance hemodialysis. In this issue, Charytan et al. showed that in patients with hyperkalemia (serum potassium concentration 5.10-6.50 mmol/l [5.1-6.5 mEq/l]) on hemodialysis, a dialysate concentration of 3 mEq/l combined with sodium zirconium cyclosilicate on dialysis-free days is associated with a lower frequency of atrial fibrillation compared with a dialysate concentration of 2 mEq/l over 8 weeks. Despite the obvious limitations such as small sample size, short treatment period, and lack of information on longer-term impact on important patient outcomes such as sudden death, this well-conceived pilot study provided impetus for larger prospective trials to test whether this personalized approach reduces major cardiovascular events and mortality.

Authors 4

1. Talat Alp Ikizler corresponding

   Vanderbilt University · Vanderbilt University Medical Center

   Affiliation as printed

   Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: alp.ikizler@vanderbilt.edu

2. Tilman Bernhard Drüeke

   Inserm · Centre de recherche en Epidémiologie et Santé des Populations

   Affiliation as printed

   Centre de recherche en Epidémiologieet Santé des Populations, Inserm Unit 1018, Team 5, CESP, Paul Brousse Hospital, Paris, France

   Inserm Unit 1018, Team 5, CESP, Paul Brousse Hospital, Paris, France

3. Jürgen Floege Aachen Division of Nephrology and Rheumatology

   RWTH Aachen University

   Affiliation as printed

   Division of Nephrology and Rheumatology, Rheinisch Westfälische Technische Hochschule (RWTH) University of Aachen, Aachen, Germany

4. Germaine Wong

   The University of Sydney

   Affiliation as printed

   Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

   The University of Sydney, Sydney, New South Wales, Australia