Pretreatment of Formula or Expressed Breast Milk With Sodium Polystyrene Sulfonate (Kayexalate®) as a Treatment for Hyperkalemia in Infants With Acute or Chronic Renal Insufficiency

Thompson, Kirsten; Flynn, Joseph T.; Okamura, Daryl M.; Zhou, Li

doi:10.1053/j.jrn.2013.02.011

Cited by 32 publications

(37 citation statements)

References 12 publications

(18 reference statements)

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“…A variety of formulas, treatment times, and medication doses have been tested; however, no single, standardized pretreatment method has been determined best for clinical practice [3–6, 8–12]. Published studies have also examined a limited number of nutrients [3–6, 8–12].…”

Section: Introductionmentioning

confidence: 99%

Renal formulas pretreated with medications alters the nutrient profile

et al. 2015

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Background Pretreating renal formulas with medications to lower the potassium and phosphorus content is common in clinical practice; however, the effect of this treatment on other nutrients is relatively unstudied. We examine whether nutrient composition is affected by pretreating renal formulas with sodium polystyrene sulfonate (SPS) suspension and sevelamer carbonate. Methods Fixed medication doses and treatment times were utilized to determine changes in the nutrient composition of Suplena® and Similac® PM 60/40. The effect of simultaneously adding both medications (co-administration) to the formula on the nutrient composition of Suplena® was also evaluated. Results Pretreatment of Suplena® with SPS reduced the concentrations of calcium (11–38 %), copper (3–11 %), manganese (3–16 %), phosphorus (0–7 %), potassium (6–34 %), and zinc (5–20 %) and increased those of iron (9–34 %), sodium (89–260 %), and sulfur (19–45 %) and the pH (0.20–0.50 units). Pretreatment of Similac® PM 60/40 with SPS reduced the concentrations of calcium (8–29 %), copper (5–19 %), magnesium (3–26 %), and potassium (33–63 %) and increased those of iron (13–87 %) and sodium (86–247 %) and the pH (0.40–0.81 units). Pretreatment of both formulas with the SPS suspension led to significant increases in the aluminum concentration in both formulas (507–3957 %). No differences in potassium concentration were observed between treatment times. Unexpectedly, the levels of neither phosphorus nor potassium were effectively reduced in Suplena® pretreated with sevelamer carbonate alone or when co-administered with SPS. Conclusions Pretreating formula with medications alters nutrients other than the intended target(s). Future studies should be aimed at predicting the loss of these nutrients or identifying alternative methods for managing serum potassium and phosphorus levels in formula-fed infants. The safety of pretreating formula with SPS suspension should also be examined.

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Section: Introductionmentioning

confidence: 99%

Renal formulas pretreated with medications alters the nutrient profile

et al. 2015

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“…Because it has some gastrointestinal side effects, and in rare cases serious side effects such as bowel necrosis, in younger children with CKD it can be used instead to “decant” the formula. Through ion exchange, the sodium content of the SPS replaces potassium, effectively reducing serum potassium an average of 24% in 48 h (65). This addition of sodium to the formula may be beneficial for children who need sodium supplementation, but is not a benefit for children needing sodium limitation.…”

Section: Unique Adjustments To Enteral Feedingsmentioning

confidence: 99%

“…The high calorie to potassium ratio, as most adult products are concentrated to allow for fluid restrictions common to dialysis, is a means to lower potassium intake while achieving adequate caloric intake for growth. However, reports of gastrointestinal intolerance have been reported with this practice and the micronutrient profile is not designed for a pediatric population (65). Thus, vitamin and mineral excesses are possible.…”

Section: Unique Adjustments To Enteral Feedingsmentioning

confidence: 99%

Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD)

Nelms

2018

Front. Pediatr.

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Growth in pediatric Chronic Kidney Disease is important for long-term outcomes including final adult height and cognitive function. However, there are many barriers for children with chronic kidney disease to achieve adequate nutritional intake to optimize growth. This review highlights these unique concerns, including route of nutrition, dialysis contributions and biochemical indices. Fitting the enteral feeding to the patients' needs involves choosing an appropriate product or products, limiting harmful nutrients in excess, notably aluminum, and altering for electrolyte and micronutrient needs. Unique adjustments to the enteral regimen include accommodating volume needs, optimizing macronutrient ratios, specific electrolyte adjustments, the blending of products together, and adjustments made to consider patient and family psychosocial needs. When a holistic approach to medical nutrition therapy is applied, taking the above factors into consideration, adequate intake for growth of the child with CKD is achievable.

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“…Similac PM 60/40 ® can be used for infants who require formulas. In severe cases, potassium content can be lowered further in formula or breast milk by mixing sodium polystyrene with formula, allowing it to settle for 30-45 min, and decanting the supernatant (leaving the sediment behind) [5,6]. Potassium is exchanged for sodium, so monitoring for hypernatremia is advisable.…”

Section: A Life Course Approach To the Renal Diet: Integration With Dmentioning

confidence: 99%

Nutrition Management in Childhood Kidney Disease: an Integrative and Lifecourse Approach

Graf

Reidy

Kaskel

2015

Pediatric Nephrology

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Pretreatment of Formula or Expressed Breast Milk With Sodium Polystyrene Sulfonate (Kayexalate®) as a Treatment for Hyperkalemia in Infants With Acute or Chronic Renal Insufficiency

Cited by 32 publications

References 12 publications

Renal formulas pretreated with medications alters the nutrient profile

Renal formulas pretreated with medications alters the nutrient profile

Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD)

Nutrition Management in Childhood Kidney Disease: an Integrative and Lifecourse Approach

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