Therapeutic Update on Oral Potassium Exchange Resin Use in Chronic Kidney Disease Patients: a Systematic Review of Randomized Controlled Clinical Trials

Overview

Journal J Pharm Pharm Sci

Specialties Pharmacology
Pharmacy

Date 2024 Jan 4

PMID 38173862

Authors

Jaclyn Gruver

Akram Al-Makki

Brian Shepler

Affiliations

Soon will be listed here.

Abstract

Hyperkalemia is a common electrolyte disorder in patients with chronic kidney disease (CKD) that increases in prevalence with the decline of glomerular fltration rate (GFR). Another risk of hyperkalemia is the use of renin-angiotensin-aldosterone system inhibitors (RAASi) and/or mineralocorticoid receptor antagonists (MRAs) in managing CKD and proteinuria. The treatment of chronic hyperkalemia is challenging especially for outpatients. Treatment options for hyperkalemia include the potassium exchange resins of which two new potassium binders, Patiromer Sorbitex Calcium, and Sodium Zirconium Cyclosilicate (SZC) have demonstrated their clinical efficacy in reducing serum potassium with a positive safety profile. The old potassium exchange resin sodium polystyrene sulfonate (Kayexalate™) has some negative side effects including colonic necrosis, hypomagnesemia, and hypernatremia. In this review and literature search, we compare the available oral potassium exchange resins, highlight their advantages and disadvantages and comment on efficacy and safety parameters specifically in CKD patients.

References

Ash S, Singh B, Lavin P, Stavros F, Rasmussen H . A phase 2 study on the treatment of hyperkalemia in patients with chronic kidney disease suggests that the selective potassium trap, ZS-9, is safe and efficient. Kidney Int. 2015; 88(2):404-11. PMC: 4526769. DOI: 10.1038/ki.2014.382. View

Kessler C, Ng J, Valdez K, Xie H, Geiger B . The use of sodium polystyrene sulfonate in the inpatient management of hyperkalemia. J Hosp Med. 2011; 6(3):136-40. DOI: 10.1002/jhm.834. View

Berlyne G, Janabi K, Shaw A, Hocken A . Treatment of hyperkalemia with a calcium-resin. Lancet. 1966; 1(7430):169-72. DOI: 10.1016/s0140-6736(66)90698-2. View

Harel Z, Harel S, Shah P, Wald R, Perl J, Bell C . Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med. 2013; 126(3):264.e9-24. DOI: 10.1016/j.amjmed.2012.08.016. View

Canas A, Troutt H, Jiang L, Tonthat S, Darwish O, Ferrey A . A randomized study to compare oral potassium binders in the treatment of acute hyperkalemia. BMC Nephrol. 2023; 24(1):89. PMC: 10074796. DOI: 10.1186/s12882-023-03145-x. View

Agarwal R, Rossignol P, Romero A, Garza D, Mayo M, Warren S . Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2019; 394(10208):1540-1550. DOI: 10.1016/S0140-6736(19)32135-X. View

Marup F, Peters C, Christensen J, Birn H . Can patiromer allow for intensified renin-angiotensin-aldosterone system blockade with losartan and spironolactone leading to decreased albuminuria in patients with chronic kidney disease, albuminuria and hyperkalaemia? An open-label randomised.... BMJ Open. 2022; 12(2):e057503. PMC: 8862471. DOI: 10.1136/bmjopen-2021-057503. View

Nasir K, Ahmad A . Treatment of hyperkalemia in patients with chronic kidney disease: a comparison of calcium polystyrene sulphonate and sodium polystyrene sulphonate. J Ayub Med Coll Abbottabad. 2015; 26(4):455-8. View

Weir M, Bakris G, Bushinsky D, Mayo M, Garza D, Stasiv Y . Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med. 2014; 372(3):211-21. DOI: 10.1056/NEJMoa1410853. View

10.

Weir M, Bakris G, Gross C, Mayo M, Garza D, Stasiv Y . Treatment with patiromer decreases aldosterone in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors. Kidney Int. 2016; 90(3):696-704. DOI: 10.1016/j.kint.2016.04.019. View

11.

Watson M, Baker T, Nguyen A, Sebastianelli M, Stewart H, Oliver D . Association of prescription of oral sodium polystyrene sulfonate with sorbitol in an inpatient setting with colonic necrosis: a retrospective cohort study. Am J Kidney Dis. 2012; 60(3):409-16. DOI: 10.1053/j.ajkd.2012.04.023. View

12.

Roger S, Lavin P, Lerma E, McCullough P, Butler J, Spinowitz B . Long-term safety and efficacy of sodium zirconium cyclosilicate for hyperkalaemia in patients with mild/moderate versus severe/end-stage chronic kidney disease: comparative results from an open-label, Phase 3 study. Nephrol Dial Transplant. 2020; 36(1):137-150. PMC: 7771984. DOI: 10.1093/ndt/gfz285. View

13.

Sullivan E, Ruegger M, Dunne I, Sutaria N, Towers W . Comparison of effectiveness and safety of sodium polystyrene sulfonate and sodium zirconium cyclosilicate for treatment of hyperkalemia in hospitalized patients. Am J Health Syst Pharm. 2023; 80(18):1238-1246. DOI: 10.1093/ajhp/zxad137. View

14.

Pitt B, Bushinsky D, Kitzman D, Ruschitzka F, Metra M, Filippatos G . Evaluation of an individualized dose titration regimen of patiromer to prevent hyperkalaemia in patients with heart failure and chronic kidney disease. ESC Heart Fail. 2018; 5(3):257-266. PMC: 5933966. DOI: 10.1002/ehf2.12265. View

15.

Mahoney B, Smith W, Lo D, Tsoi K, Tonelli M, Clase C . Emergency interventions for hyperkalaemia. Cochrane Database Syst Rev. 2005; (2):CD003235. PMC: 6457842. DOI: 10.1002/14651858.CD003235.pub2. View

16.

Bakris G, Pitt B, Weir M, Freeman M, Mayo M, Garza D . Effect of Patiromer on Serum Potassium Level in Patients With Hyperkalemia and Diabetic Kidney Disease: The AMETHYST-DN Randomized Clinical Trial. JAMA. 2015; 314(2):151-61. DOI: 10.1001/jama.2015.7446. View

17.

Raebel M . Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther. 2011; 30(3):e156-66. DOI: 10.1111/j.1755-5922.2010.00258.x. View

18.

Lepage L, Dufour A, Doiron J, Handfield K, Desforges K, Bell R . Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD. Clin J Am Soc Nephrol. 2015; 10(12):2136-42. PMC: 4670766. DOI: 10.2215/CJN.03640415. View

19.

Hagan A, Farrington C, Wall G, Belz M . Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective study. Clin Nephrol. 2015; 85(1):38-43. DOI: 10.5414/CN108628. View

20.

Fishbane S, Ford M, Fukagawa M, McCafferty K, Rastogi A, Spinowitz B . A Phase 3b, Randomized, Double-Blind, Placebo-Controlled Study of Sodium Zirconium Cyclosilicate for Reducing the Incidence of Predialysis Hyperkalemia. J Am Soc Nephrol. 2019; 30(9):1723-1733. PMC: 6727265. DOI: 10.1681/ASN.2019050450. View