HARMONIZE Trial design: Patients with hyperkalemia (K ≥5.1 mEq/L) were randomized in a 1:1:1:1.7 fashion to receive sodium zirconium cyclosilicate (ZS)

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HARMONIZE Trial design: Patients with hyperkalemia (K ≥5.1 mEq/L) were randomized in a 1:1:1:1.7 fashion to receive sodium zirconium cyclosilicate (ZS) 5 g daily, 10 g daily, 15 g daily, or placebo daily. Patients were followed for 4 weeks. Results (p < 0.001) Mean K levels between days 8-29 for ZS 5, 10, 15 vs. placebo: 4.75 vs. 4.51 vs. 4.37 vs. 5.06 mEq/L, p < 0.001 for each group vs. placebo Patients with K <5.1 mEq/L: 80% vs. 90% vs. 94% vs. 46%, p < 0.05 Edema: 2% vs. 6% vs. 14% vs. 2%; hypokalemia: 0% vs. 10% vs. 11% vs. 0% 100 50 % Conclusions ZS was safe and efficacious in the treatment of asymptomatic hyperkalemia Dose-dependent relationship in efficacy and side effects including hypokalemia was observed Long-term safety and efficacy studies with ZS are awaited Patients with K <5.1 mEq/L @ 8-29 days ZS 5g n = 45 Placebo n = 85 ZS 10g n = 51 ZS 15g n = 56 Kosiborod M, et al. JAMA 2014;312:2223-33