Calcium–Polystyrene Sulfonate Decreases Inter‐Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study

Wang, Jing; Lv, Mengmeng; Odeh, Zach; Ly, Wang; Zhou, Ming; Song, Guanghui; Zhang, Xu; Lin, Hongli

doi:10.1111/1744-9987.12723

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…Sixteen studies (n=1,582 participants) were enrolled including clinical trials (n=15) and a retrospective cohort (n=1) 23-38. The studies were published between 1989 and 2018 and described different therapies, mainly for patients diagnosed with chronic kidney disease (n=11).…”

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%

“…We noticed statistical significance in six comparisons: I) insulin + glucose vs. glucose alone, II) SPS vs. placebo, III) 2.5 g ZS-9 vs. placebo; IV) 5 g ZS-9 vs. placebo, V) 10 g ZS-9 vs. placebo, and VI) 3-5 g CPS three times/day vs. no treatment (Table 2). 28,32,33,38 All these treatments were prescribed for CKD patients.…”

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%

“…This systematic review identified 4 RCTs investigating the use of polystyrene resins in the setting of hyperkalemia. 32,37,38,46 Lepage et al and Wang et al studied the efficacy of polystyrene resins in placebo-controlled trials. Nakayama et al and Nasir and Ahmad compared SPS with an active comparator, CPS.…”

Section: Included Study Designsmentioning

confidence: 99%

“…Both placebo-controlled RCTs reported hypokalemia; however, neither found that the rate was statistically different between treatment and placebo arms within the follow-up period of 6.9 days to 3 weeks. 32,46 Two studies studied hypercalcemia while using CPS (Arroyo et al and Sevitt and Wrong). The follow-up time was 3 and 8.3 months, respectively.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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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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Potassium binders for chronic hyperkalaemia in people with chronic kidney disease

Natale

Palmer

Ruospo

et al. 2020

Cochrane Database of Systematic Reviews

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Calcium–Polystyrene Sulfonate Decreases Inter‐Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study

Cited by 12 publications

References 17 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

Potassium binders for chronic hyperkalaemia in people with chronic kidney disease

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