Erratum Regarding “Dialysate and Serum Potassium in Hemodialysis” (Am J Kidney Dis. 2015;66[1]:125-132)

Erratum Erratum Regarding “Dialysate and Serum Potassium in Hemodialysis” (Am J Kidney Dis. 2015;66[1]:125-132) In the In Practice article entitled “Dialysate and Serum Potassium in Hemodialysis” that appeared in the July 2015 issue of AJKD (Hung & Hakim, volume 66, issue 1, pages 125-132), there were errors in the description, dose information, and reported results for 2 new oral agents for the treatment of hyperkalemia. In particular, sentences 2 through 5 of the second paragraph of the section “Nondialytic Treatment of Potassium in End-Stage Renal Disease” on page 129 (“Two new oral agents recently have been tested in doubleblind randomized phase 3 trials for the treatment of hypokalemia in patients with CKD, but not in dialysis patients yet. The first is a polymer-based agent, sodium zirconium cyclosilicate (ZS-9; ZS Pharma Inc), and the other is an ion-exchanging potassium sequestrant, patiromer. Both agents were effective in significantly increasing the percent of patients with normokalemia (potassium, 3.5-5.0 mEq/L) to 84% in 24 hours and 98% in 48 hours. Hypokalemia primarily was seen in patients assigned a dose $ 10 mg/d compared to none in the 5-mg/d or placebo group.25,26”) should have read as follows: Two new oral agents recently have been tested in double-blind randomized phase 3 trials for the treatment of hyperkalemia in patients with CKD, but not in dialysis patients yet. The first is a highly selective cation exchanger (sodium zirconium cyclosilicate [ZS-9; ZS Pharma Inc]) that sequesters potassium ions in exchange for sodium and hydrogen ions in the intestinal tract, and the other is a nonabsorbed polymer-based agent (patiromer) that binds potassium ions in exchange for calcium ions, mainly in the distal colon, which has the highest concentrations of free potassium. Both agents were effective in significantly increasing the percentage of patients with normokalemia (potassium, 3.5-5.0 mEq/L).25,26 ZS-9 was found to achieve a significant reduction in potassium levels within 1 hour after administration and normokalemia in 84% and 98% of participants by 24 and 48 hours, respectively. Hypokalemia and mild peripheral edema were seen primarily in patients assigned a dose $ 10 g/d versus those in the 5-g/d or placebo groups.37 For patients receiving patiromer (4.2 or 8.4 g, twice daily), potassium levels declined by an average of 1.01 6 0.03 mEq/L at week 4, and 76% (95% confidence interval, 70%-81%) of the patients reached the target potassium level (3.8-,5.1 mEq/L) at that time.26 The incidence of hypokalemia (serum potassium ,3.5 mEq/L) was 3%. No clinically relevant change in kidney function, calcium concentration, or levels of other electrolytes was observed.

The corrected passage adds a citation to a new reference 37, which should read as follows: 37. Kosiborod M, Rasmussen HS, Lavin P, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: The HARMONIZE randomized clinical trial. JAMA. 2014;312(21):2223-2233.

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