Pharmacological interventions for the acute management of hyperkalaemia in adults

Batterink, Josh; Cessford, Tara A.; Taylor, Robert Ai

doi:10.1002/14651858.cd010344.pub2

Cited by 36 publications

(47 citation statements)

References 50 publications

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“…195 Administration of 5 units of regular insulin appears as effective in lowering potassium concentration as the administration of 10 units, although evidence is limited; hypoglycemia is a potential complication. 197,198 In addition, or as an alternative to insulinglucose, administration of b-agonists is suggested. 195 Use of 10 mg salbutamol via nebulizer results in significant reduction of potassium at a peak of 120 minutes after use (90 minutes for 20 mg).…”

Section: Acute Hyperkalemiamentioning

confidence: 99%

“…195 Use of 10 mg salbutamol via nebulizer results in significant reduction of potassium at a peak of 120 minutes after use (90 minutes for 20 mg). 197 Increased heart rate, tremors, palpitations, and mild anxiety were reported adverse effects. 193 Concomitant use of insulin-glucose and salbutamol is feasible, additive, and internationally recommended.…”

Section: Acute Hyperkalemiamentioning

confidence: 99%

See 1 more Smart Citation

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Clase

Carrero

Ellison

et al. 2020

Kidney International

314

303

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Section: Acute Hyperkalemiamentioning

confidence: 99%

Section: Acute Hyperkalemiamentioning

confidence: 99%

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Clase

Carrero

Ellison

et al. 2020

Kidney International

314

303

View full text Add to dashboard Cite

show abstract

“…Although these treatments are widely used in clinical practice, it should be recognized that, as also shown by a recent Cochrane review, standardized therapeutic protocols do not exist [36]. So, in a prospective multicenter study exploring real-life hyperkalemia management in many EDs, it has been shown that there was a great heterogeneity among the different sites, while, even if insulin/glucose was the most common therapy employed, in the majority of the patients multiple treatments were prescribed [37].…”

Section: Hyperkalemia: Treatment Strategiesmentioning

confidence: 99%

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Esposito

Conti

Falqui

et al. 2020

JCM

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Hyperkalemia may cause life-threatening cardiac and neuromuscular alterations, and it is associated with high mortality rates. Its treatment includes a multifaceted approach, guided by potassium levels and clinical presentation. In general, treatment of hyperkalemia may be directed towards stabilizing cell membrane potential, promoting transcellular potassium shift and lowering total K+ body content. The latter can be obtained by dialysis, or by increasing potassium elimination by urine or the gastrointestinal tract. Until recently, the only therapeutic option for increasing fecal K+ excretion was represented by the cation-exchanging resin sodium polystyrene sulfonate. However, despite its common use, the efficacy of this drug has been poorly studied in controlled studies, and concerns about its safety have been reported. Interestingly, new drugs, namely patiromer and sodium zirconium cyclosilicate, have been developed to treat hyperkalemia by increasing gastrointestinal potassium elimination. These medications have proved their efficacy and safety in large clinical trials, involving subjects at high risk of hyperkalemia, such as patients with heart failure and chronic kidney disease. In this review, we discuss the mechanisms of action and the updated data of patiromer and sodium zirconium cyclosilicate, considering that the availability of these new treatment options offers the possibility of improving the management of both acute and chronic hyperkalemia.

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“…16,17 In 2009, the U.S. Food and Drug Administration (FDA) subsequently published a black box warning highlighting the association with colonic necrosis and recommended against coadministration with sorbitol. 8 The role of sorbitol in generating intestinal injury remains unclear. Two studies using rat models, Ayoub et al and Lillemoe et al, provide conflicting conclusions on the culpability of SPS in the observed mortality and colonic necrosis.…”

Section: Introductionmentioning

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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Pharmacological interventions for the acute management of hyperkalaemia in adults

Cited by 36 publications

References 50 publications

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Polysulfonate Resins in Hyperkalemia: A Systematic Review

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