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Sodium polystyrene sulfonate may reduce serum potassium in CKD, ESKD
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A single dose of sodium polystyrene sulfonate decreased serum potassium levels in patients with both chronic kidney disease and ESKD, potentially providing an effective treatment for hyperkalemia in this patient population, according to a published study.
“The use of sodium polystyrene sulfonate for the treatment of hyperkalemia lacks sufficient efficacy data in patients with chronic kidney disease and end-stage renal disease; however, use remains widespread,” Taylor V. Hunt, of the department of pharmacy at University of Kentucky HealthCare, and colleagues wrote. “Recent evidence suggests that this population may be at risk for serious gastrointestinal adverse effects with sodium polystyrene sulfonate.”
To evaluate the effects of sodium polystyrene sulfonate for acute hyperkalemia, researchers conducted a retrospective cohort study of 114 patients with stage 4 or 5 CKD or ESKD who also had serum potassium greater than 5 mEq/L (mean age, 66 years; 52% were women; 62% were African American). The primary outcome of the study was decrease in potassium within 24 hours after 30 grams of oral sodium polystyrene sulfonate was administered. Also considered were the decrease in potassium within 24 hours after taking a 15-gram or 30-gram dose and gastrointestinal adverse effects.
Between 14 and 16 hours after administration of sodium polystyrene sulfonate, researchers observed a median serum potassium decrease of 0.8 mEq/L after a 30-gram dose and a median decrease of 0.7 mEq/L after either a 15-gram or 30-gram dose.
Within 30 days of taking sodium polystyrene sulfonate, gastrointestinal side effects—including gastrointestinal ulceration and rectal hemorrhaging — occurred in 5% of patients, but researchers noted only two cases were classified as being “possibly associated” by WHO-Uppsala Monitoring Center causality assessment system.
“The use of single-dose sodium polystyrene sulfonate monotherapy resulted in a significant decrease in serum potassium levels within 24 hours in patients with CKD stages 4, 5 or ESRD, irrespective of dose,” the researchers wrote. “However, it remains unclear if sodium polystyrene sulfonate is associated with an increased risk of gastrointestinal injury in this population.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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