Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients.
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ABSTRACT: Background
Calcium polystyrene sulfonate (CPS) has long been used to treat hyperkalemia in patients with chronic kidney disease (CKD). However, its efficacy and safety profile have not been systematically explored. We investigated the long-term efficacy of oral CPS for treating mild hyperkalemia on an outpatient basis.Methods
We performed a retrospective analysis of ambulatory CKD patients who were prescribed CPS for > 1 week because of elevated serum potassium levels > 5.0 mmol/L. Patients were divided into four groups according to the length of time that they took a fixed dosage of CPS (Group 1, < 3 months; Group 2, 3-6 months; Group 3, 6-12 months; and Group 4, > 1 year). Response was defined as a decrease in the serum potassium level (> 0.3 mmol/L) after treatment with CPS.Results
We enrolled a total of 247 adult patients with a basal eGFR level of 30 ± 15 mL/min/1.73 m2. All patients took small doses of CPS (8.0 ± 3.6 g/d), and serum potassium decreased in a dose-dependent fashion. Serum potassium of all patients decreased significantly from 5.8 ± 0.3 mmol/L to 4.9 ± 0.7 mmol/L with CPS treatment (P < 0.001). The response rates were 79.9%, 71.4%, 66.7%, and 86.8% in Groups 1, 2, 3, and 4, respectively. No serious adverse effects were reported during CPS administration, though constipation was noted in 19 patients (8%).Conclusion
Small doses of oral CPS are effective and safe for controlling mild hyperkalemia in CKD patients over a long period of time.
SUBMITTER: Yu MY
PROVIDER: S-EPMC5362098 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSodium and calcium polystyrene sulfonate (SPS/CPS) cation-exchange resins have had long-standing clinical use for hyperkalemia in patients with chronic kidney disease (CKD). However, uncertainty exists regarding the real-world usage of SPS/CPS for acute and chronic management of hyperkalemia. We evaluated the prescription patterns of SPS/CPS and their impact on renin-angiotensin-aldosterone system inhibitor (RAASi) treatment in patients with CKD Stages G3-G5 after an episode of de novo hyperkalemia.MethodsWe conducted a retrospective cohort study using population-level administrative databases in Manitoba, Canada, which included adults with CKD and a RAASi prescription who had an episode of de novo hyperkalemia (≥5.5 mmol/L) between January 2007 and December 2017.ResultsA total of 10 009 individuals were included in our study cohort. Among the study population, 4% received an SPS/CPS prescription within 30 days of their hyperkalemia episode. Of those, 22% received a 1-day supply of SPS/CPS and 7% received a prescription for more than 30 days. There were 8145 patients using RAASi at baseline who survived 90 days after their first hyperkalemia episode. Of those, 1447 (18%) discontinued their RAAS inhibitor and 339 (5%) received a prescription of SPS/CPS. Also, the proportion of patients who discontinued their RAASi was similar among those who did and did not receive a prescription of SPS/CPS.ConclusionIn patients with CKD receiving RAASi therapy, there is a low frequency of SPS/CPS prescription after an episode of hyperkalemia. RAASi discontinuation or downtitration is the most used pharmacologic approach for the management of hyperkalemia, a strategy that deprives patients of the cardiac and renal protective benefits of RAASi. New options for the management of hyperkalemia in this population are needed.
| S-EPMC9394712 | biostudies-literature
Project description:IntroductionHyperkalemia is a serious medical condition that often manifests in patients with chronic kidney disease and heart failure. Renin-angiotensin-aldosterone system inhibitors are known to improve outcomes in these disease states but can also cause drug-induced hyperkalemia. New therapeutic options exist for managing hyperkalemia in these patients which warrant evidence-based evaluation.AimThe objective of this article was to review the efficacy and safety evidence for patiromer, sodium zirconium cyclosilicate (ZS9), and sodium polystyrene sulfonate (SPS) for the treatment of hyperkalemia.Evidence reviewCurrent treatment options to enhance potassium excretion are SPS and loop diuretics, which are complicated by ambiguous efficacy and known toxicities. Patiromer and ZS9 are new agents designed to address this treatment gap. Both unabsorbable compounds bind potassium in the gastrointestinal (GI) tract to facilitate fecal excretion. The capacity to bind other medications in the GI tract infers high drug-drug interaction potential, which has been demonstrated with patiromer but not yet investigated with ZS9 or SPS. Phase II and III clinical trials of patiromer and ZS9 demonstrated clear evidence of a dose-dependent potassium-lowering effect and the ability to initiate, maintain, or titrate renin-angiotensin-aldosterone system inhibitors. There is limited evidence base for SPS: two small clinical trials indicated potassium reduction in chronic hyperkalemia. All agents may cause adverse GI effects, although they are less frequent with ZS9. Concerns remain for SPS to cause rare GI damage. Electrolyte abnormalities occurred with patiromer and SPS, whereas urinary tract infections, edema, and corrected QT-interval prolongations were reported with ZS9.ConclusionPatiromer and ZS9 have improved upon the age-old standard SPS for the treatment of hyperkalemia. Additional research should focus on drug-drug interactions in patients on multiple medications, incidence of rare adverse events, and use in high-risk populations.
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Project description:Background and objectivesThe study was conducted to identify a conversion factor for switching from previous erythropoiesis-stimulating agents (ESAs) to continuous erythropoietin receptor activator-methoxy polyethylene glycol-epoetin beta (C.E.R.A.) and to document the efficacy and long-term safety of C.E.R.A. in pediatric patients with anemia of CKD undergoing hemodialysis.Design, setting, participants, & measurementsIn this open-label, multicenter study, patients aged 6-17 years, with stable chronic anemia of CKD, undergoing hemodialysis received C.E.R.A. every 4 weeks, at a starting dose determined by previous weekly epoetin alfa/beta or darbepoetin dosing. After a 16-week dose-titration and a 4-week evaluation period, patients with stable hemoglobin could enter a 1-year optional safety extension.ResultsA total of 64 patients were enrolled. A conversion factor (4 µg every 4 weeks for each weekly dose of 125 IU epoetin alfa/beta or 0.55 µg darbepoetin) was identified that allowed patients to maintain hemoglobin within target levels on switching to C.E.R.A. from another ESA. Using this conversion factor, the adjusted mean change in hemoglobin from baseline to evaluation was -0.09 g/dl (95% confidence interval, -0.45 to 0.26); 81% of patients maintained hemoglobin within 10.0-12.0 g/dl and 75% maintained hemoglobin within 1.0 g/dl of baseline. Results were consistent across age groups (6-11 and 12-17 years) and previous ESA. Thirty-seven patients entered the safety extension period and 17 completed 73 weeks of treatment. Most withdrawals were for kidney transplantation. A total of 70% of patients had hemoglobin within 10.0-12.0 g/dl at last observation, and 62% were within ±1.0 g/dl of baseline. Safety was similar to studies in adult patients, with no new signal detected.ConclusionsUsing a defined conversion factor, 4-weekly C.E.R.A. was efficacious in maintaining hemoglobin levels in pediatric patients with stable anemia of CKD undergoing hemodialysis, switching from maintenance treatment with epoetin alfa/beta or darbepoetin. Safety was consistent with the known C.E.R.A. safety profile in adults.
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Project description:BackgroundHyperkalemia is a common and life-threatening complication of CKD. We aimed to develop and validate a nomogram that could identify the risk of hyperkalemia (≥5.5 mmol/L) in patients with CKD.MethodsA retrospective cohort study was performed in adult patients with predialysis advanced CKD (stages ≥3) in 2020-2021 for the outcome of hyperkalemia within 6 months. The training set was used to identify risk factors of hyperkalemia. Then a nomogram was developed by multivariable logistic regression analysis. C-statistics, calibration curves, and decision curve analysis (DCA) were used, and the model was validated in the internal and two external validation sets.ResultsIn total, 847 patients with advanced CKD were included. In 6 months, 28% of patients had hyperkalemia (234 out of 847). Independent risk factors were: age ≥75 years, higher CKD stages, previous event of serum potassium ≥5.0 mmol/L within 3 months, and comorbidities with heart failure, diabetes, or metabolic acidosis. Then the nomogram on the basis of the risk factors adding the use of renin-angiotensin-aldosterone system inhibitors was constructed. The C-statistic of the model was 0.76 (95% CI, 0.70 to 0.78), and was stable in both the internal validation set (0.73; 95% CI, 0.63 to 0.82) and external validation sets (0.88; 95% CI, 0.84 to 0.95 and 0.82; 95% CI, 0.72 to 0.92). Calibration curves and DCA analysis both found good performances of the nomogram.ConclusionA feasible nomogram and online calculator were developed and validated to evaluate the risk of hyperkalemia within 6 months in patients with advanced CKD. Patients with CKD and a high risk of hyperkalemia may benefit from intensive monitoring and early triage.
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Project description:BackgroundHyperkalaemia is frequent in haemodialysis (HD) patients and associated with increased cardiovascular mortality. Despite routine clinical use, evidence regarding the efficacy of potassium (K+) binders in HD is scant. We wished to compare the efficacy of patiromer (PAT) and sodium polystyrene sulfonate (SPS) on K+ levels in this setting.MethodsWe screened patients in three HD centres with pre-HD K+ value between 5.0 and 6.4 mmol/L, after an initial 2-week washout period for those previously on K+ binders. We included patients in an unblinded two-arm crossover trial comparing SPS 15 g before each meal on non-dialysis days with PAT 16.8 g once daily on non-dialysis days with randomized attribution order and a 2-week intermediate washout period. The primary outcome was the mean weekly K+ value.ResultsWe included 51 patients and analysed 48 with mean age of 66.4 ± 19.4 years, 72.9% men and 43.4% diabetics. Mean weekly K+ values were 5.00 ± 0.54 mmol/L, 4.55 ± 0.75 mmol/L and 5.17 ± 0.64 mmol/L under PAT (P = .003), SPS (P < .001) and washout, respectively. In direct comparison, K+ values and prevalence of hyperkalaemia were lower under SPS as compared with PAT (P < .001). While the incidence of gastrointestinal side effects was similar between treatments, SPS showed lower subjective tolerability score (6.0 ± 2.4 and 6.9 ± 1.9) and compliance (10.8 ± 20.4% and 2.4 ± 7.3% missed doses) as compared with PAT (P < .001 for both).ConclusionBoth PAT and SPS are effective in decreasing K+ levels in chronic HD patients. However, at the tested doses, SPS was significantly more effective in doing so as compared with PAT, despite lower tolerability and compliance. Larger randomized controlled trials should be conducted in order to confirm our findings and determine whether they would impact clinical outcomes.
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