To Bind or to Let Loose: Effectiveness of Sodium Polystyrene Sulfonate in Decreasing Serum Potassium

Abstract

Background. The use of sodium polystyrene sulfonate in decreasing serum potassium has recently been questioned due to the lack of documented effectiveness. Methods. A retrospective cohort analysis of all hospitalized patients who received sodium polystyrene sulfonate over four months was performed. The change in serum potassium was noted over a period of 24 hours. Patients who received any other form of potassium-altering drug or treatment were excluded. Results. The administration of sodium polystyrene sulfonate reduced serum potassium by 16.7% (P < 0.001) as compared to the baseline serum potassium over a period of 24 hours. During this same time, no change in serum creatinine was identified (P = 0.73). In addition, there was no correlation between potassium and creatinine change (r2 = 0.0004 and P = 0.99). Patients with higher initial serum potassium (≥5.6 mEq/L) reduced their potassium concentration 4% more than those with initial serum potassium of <5.6 mEq/L; however, this reduction did not reach statistical significance (P = 0.32). There was no significant difference in the effectiveness of 15 gm and 30 gm resin preparation (P = 0.54). Thirteen deaths were noted in our cohort, of which one death was due to ischemic colitis. Conclusion. We conclude that sodium polystyrene sulfonate is effective in lowering serum potassium.

Evidence in support of hyperkalaemia management strategies: A systematic literature review

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Patiromer induces rapid and sustained potassium lowering in patients with chronic kidney disease and hyperkalemia

“…The use of an active control such as sodium polystyrene sulfonate, the only drug specifically indicated for the treatment of hyperkalemia in the United States, was also considered but was felt to be inappropriate because of the lack of prospective, controlled trials demonstrating the efficacy of this agent, its potential to cause intestinal necrosis as detailed in the prescribing information, 23 and its poor gastrointestinal tolerability making blinding difficult. 8 , 9 , 10 , 11 , 12 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32…”

Cation Exchange Resins and colonic perforation. What surgeons need to know

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