Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia

Nakayama, Yosuke; Ueda, Kaoru; Yamagishi, Sho‐ichi; Sugiyama, Miki; Yoshida, Chikara; Kurokawa, Yuka; Nakamura, Nao; Moriyama, Takuzou; Kodama, Goh; Minezaki, Tomohisa; Ito, Sohei; Nagata, Akihisa; Taguchi, Kensei; Yano, Junko; Kaida, Yusuke; Shibatomi, Kazutaka; Fukami, Kei

doi:10.1007/s10157-017-1412-y

Cited by 26 publications

(17 citation statements)

References 43 publications

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“…reported one interruption (17%) in the insulin + glucose group and none in the glucose group due to serious hypoglycemia 28,32. Nakayama et al reported five interruptions [edema (n=3), diarrhea (n=1) and headache (n=1)] in the CPS group and none in the SPS group 37…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Varallo¹,

Trombotto

Lucchetta

et al. 2019

Pharm Pract (Granada)

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Background: Although the management of hyperkalemia follows expert guidelines, treatment approaches are based on traditionally accepted practice standards. New drugs have been assessed such as sodium zirconium cyclosilicate and patiromer; however, their safety and efficacy or effectiveness have not yet been compared to traditional pharmacotherapy. Objective: The present systematic review had the purpose to evaluate the efficacy, effectiveness, and safety of hyperkalemia pharmacotherapies. Methods: PubMed, LILACS, Cochrane Library, and ClinicalTrials were searched through November 2018. Clinical trial, cohort and case-control were searched. The risk of bias (RoB v2.0 and ROBINS-I) and quality of evidence (GRADE) at the level of outcomes were assessed. Results: Sixteen clinical trials and one retrospective cohort were identified regarding efficacy and safety of 24 different alternatives. The management of hyperkalemia remains empirical and off-label, since sodium zirconium cyclosilicate and patiromer are not available in several countries and further studies are required to assess efficacy, effectiveness and safety. Sodium or calcium polystyrene sulfonate (moderate confidence), sodium zirconium cyclosilicate (moderate confidence), and insulin plus dextrose (moderate confidence) showed superior efficacy to, respectively, placebo, no treatment, placebo, and dextrose. Other therapies (low confidence) showed similar efficacy compared to active or inactive alternatives. Most of the adverse events reported were nonspecific, so it was not possible to assign the cause and to classify as defined or probable. Conclusions: Comparative cohort and case-control studies are need to evaluate the safety and effectiveness of new and traditional pharmacotherapies to support the development of guidelines about acute and chronic hyperkalemia, with high-quality evidence.

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Section: Resultsmentioning

confidence: 99%

“…Only three studies reported the discontinuation of treatments due to adverse drug reactions 28,32,37. Lepage et al .…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Varallo¹,

Trombotto

Lucchetta

et al. 2019

Pharm Pract (Granada)

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“…After applying the exclusion criteria and removal of duplicates, 30 articles were eligible for inclusion ( Table 1 ). 10 , 12 , 15 , 28 - 54 Of the included studies, 4 studies were RCTs, 21 were observational studies ( Table 2 ), and 5 studies were nonrandomized interventional study designs (quasi-experimental study designs) ( Table 3 ). Most of the literature was published since 2010: 4 articles were published before 1990, 1 between 1990 and 2000, 3 between 2000 and 2010, and 22 were published since 2010.…”

Section: Resultsmentioning

confidence: 99%

Polysulfonate Resins in Hyperkalemia: A Systematic Review

Wong

Zhang

Norman³

et al. 2020

Can J Kidney Health Dis

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Background: Hyperkalemia is a potentially life-threatening electrolyte abnormality defined as a serum potassium above the lab reference range (usually >5.0-5.5 mEq/L). Polystyrene resins, including sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS), have long been used to treat hyperkalemia. Sodium polystyrene sulfonate/calcium polystyrene sulfonate act by exchanging a cation for potassium within the intestinal lumen. While SPS and CPS have been available since the 1960s, there are rising concerns about the validity of the data supporting its use and about serious adverse gastrointestinal effects. Objective: The objective of this systematic review was to quantify the efficacy and safety of polystyrene sulfonate resins (SPS/CPS) in the treatment of adults with hyperkalemia. This review focuses on the randomized control trial (RCT), interventional non-RCT, and observational data available on SPS/CPS use. Design: Systematic review. Setting: Any country of origin. Both inpatient and outpatient settings. Patients: Adults with hyperkalemia treated with polystyrene sulfonate resins. Measurements: The primary outcome was change in serum potassium. The secondary outcomes included adverse effects of SPS/CPS and prevention of recurrent hyperkalemia. Methods: We conducted a systematic review using Cochrane Library, EMBASE (1947-2019), and Medline (1946-2019) databases. Literature reviews, systematic reviews, case studies, case series, and editorial pieces were excluded. Included studies were assessed for risk of bias. Results: Four RCTs, 21 observational studies, and 5 quasi-experimental trials were included. A total of 212 351 patients were included. Two thousand and fifty-eight patients were studied for the primary outcome and 210 293 patients were studied for the secondary outcomes. Study designs were heterogeneous and not amenable to meta-analysis. Most studies included nonhemodialysis outpatients older than 65 years. Of the included studies, 22/25 (88%) demonstrated a reduction of serum potassium >0.5 mEq/L over the study period. The magnitude of reduction in serum potassium of potassium resin compared with placebo or matched controls in the 3 low-risk studies identified was 0.14 to 1.04 mEq/L. However, each study used different dosing regimens. Ten of 22 studies reported the effects of polystyrene resins on serum potassium within 24 hours. A few high-quality observational studies suggest an increased risk of serious adverse gastrointestinal events with a relative risk of 2.10 and a hazard ratio of 1.25 to 1.94; however, the absolute risk remains low. The incidence of adverse gastrointestinal events is 16 to 23 events per 1000 person-years. Limitations: We acknowledge several limitations in this study. Case studies and case series were excluded from the search results. Large case series may have been excluded despite having comparable sample sizes to studies included due to lack of a comparator and calculated estimates. Due to the heterogeneity of the studies, the data were unable to be meta-analyzed and as such the potassium-lowering effect of polystyrene sulfonate resins remains founded on small studies with potential confounders. Conclusions: This systematic review demonstrates a continued lack of high-quality evidence for the use of SPS/CPS in hyperkalemia. Studies investigated highly variable timelines and the most robust evidence for SPS/CPS use is in chronic hyperkalemia. While the absence of high-quality evidence does not exclude the possibility of benefit, prescribers must understand that the use of SPS/CPS in acute hyperkalemia is not supported by high-quality evidence. Trial registration: The protocol for this systematic review was not registered.

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“…Recently, a comparative study between CPS and SPS was reported from Japanese pre-dialysis patients with hyperkalemia20). After 4-week treatments, serum potassium lowering was similar (CPS, 0.60 to 1.90mmol/L; SPS, 1.08 to 1.88 mmol/L, p=0.51).…”

Section: Potassium Binders To Treat Chronic Hyperkalemia In Ckdmentioning

confidence: 94%

“…Calcium polystyrene sulfonate (CPS) is a cation exchange resin, which exchanges calcium for potassium. Compared with SPS, CPS may have a higher potassium-selectivity at cation exchange20). Although CPS has been widely used for patients with advanced CKD in many countries including South Korea, few studies were reported on its efficacy and adverse effects.…”

Section: Potassium Binders To Treat Chronic Hyperkalemia In Ckdmentioning

confidence: 99%

Pharmacologic Treatment of Chronic Hyperkalemia in Patients with Chronic Kidney Disease

Kim

2019

Electrolyte Blood Press

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Hyperkalemia is frequently complicated in patients with advanced chronic kidney disease (CKD) because kidney is the major route of potassium excretion. Urinary potassium excretion is reduced according to the decline in glomerular filtration rate, and the risk of hyperkalemia is increased in patients with high potassium intake, advanced age, diabetes mellitus, congestive heart failure, and medications such as renin-angiotensin-aldosterone system(RAAS) blockades. On the other hand, the benefits of RAAS blockades and a high-potassium diet should be considered in CKD patients. To overcome these contradictory treatment strategies, potassium binders have emerged as new options to enhance fecal potassium excretion. In different regions of the world, four types of potassium binders are preferentially used. Whereas sodium polystyrene sulfonate (SPS) exchanges sodium for potassium, calcium polystyrene sulfonate (CPS) has the advantage of avoiding hypervolemia because it exchanges calcium for potassium. SPS was first introduced in the 1950s and used for a long time in western countries, and CPS is currently prescribed in Asia including South Korea. In contrast with the paucity of clinical studies using SPS or CPS, the recent randomized, controlled trials reported that two newer potassium binders, patiromer and sodium zirconium cyclosilicate (ZS-9), effectively and safely reduce serum potassium levels in CKD patients taking RAAS blockades. Our experiences showed that the long-term administration of a small dose of CPS was also effective and safe in treatment of chronic hyperkalemia. Further comparative trials among patiromer, ZS-9, and CPS are required to provide guides to cost-effective management of hyperkalemia in CKD patients.

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Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia

Abstract: Compared with SPS, CPS may be safer for the treatment of hyperkalemia in pre-dialysis patients, because it did not induce hyperparathyroidism or volume overload.

Cited by 26 publications

References 43 publications

Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Polysulfonate Resins in Hyperkalemia: A Systematic Review

Pharmacologic Treatment of Chronic Hyperkalemia in Patients with Chronic Kidney Disease

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