Sodium polystyrene sulfonate reduces hyperkalemia in CKD, ESRD

  • Hunt TV & al.
  • Clin Kidney J
  • 1 Jun 2019

  • International Clinical Digest
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Takeaway

  • A single dose of sodium polystyrene sulfonate (SPS) reduces hyperkalemia in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).

Why this matters

  • SPS use in this population is widespread despite lack of sufficient efficacy data.
  • Gastrointestinal safety remains unclear.

Study design

  • Study of 114 adults with CKD (stage IV, 30%; stage V, 14%) or dialysis-dependent ESRD (56%), and serum potassium >5 (median, 5.7) mEq/L.
  • Patients (mean age, 66 years; 52% women) received a single dose of 15 mg (n=53) or 30 mg (n=61) SPS, suspended in 33% sorbitol.
  • Funding: None.  

Key results

  • Potassium levels were evaluated at a median 14 (interquartile range [IQR], 10-18) hours after 30 g SPS and 16 (IQR, 12-19) hours after 15 g SPS.
  • Median potassium decreased by SPS dose (IQRs):
    • 30 g: 0.8 mEq/L (0.4-1.1 mEq/L; P<.001>
    • 15 g: 0.5 mEq/L (0.2-0.9 mEq/L; P<.001>
    • 15 or 30 g SPS: 0.7 mEq/L (0.4-1.0 mEq/L; P<.001 significance retained in esrd-only analysis meq>
  • 56% of patients experienced normokalemia.
  • 6 patients (5%) experienced serious gastrointestinal events within 30 days, but only 2 cases were potentially related to SPS.

Limitations

  • Single-center, retrospective design.
  • Mostly mild hyperkalemia.

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