Dose-response to a jelly preparation of calcium polystyrene sulfonate in patients with hyperkalemia  changes in serum potassium levels with or without a RAAS inhibitor

Tomino, Yasuhiko; Yamazaki, Tomoyuki; Shou, Ichiyu; Tsuge, Tomohiko; Satake, Kenichi; Takeda, Yoshito; Ohtani, Atsuko; Nishitani, Tomohito; Kurusu, Atsushi; Hamada, Chikuma; Horikoshi, Satoshi; Maeda, Keiko; Tanaka, Yosuke; Fukuda, Hitoshi; Wakabayashi, M; Seto, Takeru

doi:10.5414/cnp68379

Cited by 9 publications

(8 citation statements)

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“…Serum potassium concentrations decreased by 0.68 mmol/L at 5 g/d, 0.96 mmol/L at 10 g/d, and 1.32 mmol/L at 15 g/d. These responses were similar to the results from Tomino et al, in which Argamate jelly was used in 23 CKD patients [18]. …”

Section: Discussionsupporting

confidence: 89%

Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients

Yeo

Park

et al. 2017

PLoS ONE

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BackgroundCalcium 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.MethodsWe 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.ResultsWe 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%).ConclusionSmall doses of oral CPS are effective and safe for controlling mild hyperkalemia in CKD patients over a long period of time.

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Section: Discussionsupporting

confidence: 89%

Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients

Yeo

Park

et al. 2017

PLoS ONE

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“…Of the 29 unique non‐randomised interventional studies identified in this SLR, 13 investigated temporising agents and 6 ZS or organic cation‐binding agents for the management of hyperkalaemia . Twelve out of 43 unique observational studies identified in the SLR reported on management of hyperkalaemia with SPS or CPS and 11 focused on temporising agents; however, a comparison of temporising agents was not in the scope of this work, given their use in the emergency setting …”

Section: Resultsmentioning

confidence: 99%

“…Among the 102 studies, Of the 29 unique non-randomised interventional studies identified in this SLR, 13 investigated temporising agents [43][44][45][46][47][48][49][50][51][52][53][54][55] and 6 ZS or organic cation-binding agents for the management of hyperkalaemia. [56][57][58][59][60][61] Twelve out of 43 unique observational studies identified in the SLR reported on management of hyperkalaemia with SPS or CPS 62-73 and 11 focused on temporising agents; however, a comparison of temporising agents was not in the scope of this work, given their use in the emergency setting. [74][75][76][77][78][79][80][81][82][83][84] Non-systematic or narrative reviews Case reports Commentaries and editorials SLRs or network meta-analyses (NMAs) of relevant studies were included at title/abstract review stage for the purpose of identifying any additional studies not identified in the database searches, but subsequently excluded at full-text review stage…”

Section: Identified Evidence On Hyperkalaemia Managementmentioning

confidence: 99%

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

et al. 2018

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“…The standard deviation of the difference between the groups was estimated. A reduction of 1.33 mmol/L in serum potassium with Ca‐PS (15 g/day) was assumed according to the study by Tomino et al . Assuming a dropout rate of ~15%, 28 patients per group were needed for appropriate analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Ca‐PS may be an ideal medication for sodium‐restricted patients with CRF . The efficacy of Ca‐PS has been demonstrated in patients with hyperkalemia . However, Panarelli et al proposed that Ca‐PS can cause serious adverse events, including gastrointestinal symptoms and colonic stenosis .…”

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confidence: 99%

Calcium–Polystyrene Sulfonate Decreases Inter‐Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study

Wang

Odeh

et al. 2018

Ther Apher Dial

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Hyperkalemia is a life-threatening emergency in maintenance hemodialysis (MHD) patients. This clinical trial investigated the efficacy and safety of calcium-polystyrene sulfonate (Ca-PS) in MHD patients with interdialytic hyperkalemia. A total of 58 hemodialysis patients with hyperkalemia (≥5.5 mol/L) were selected and administered either a 3-week Ca-PS (3 × 5 g/day) or a blank control following the model of a prospective, randomized, crossover clinical trial with a 1-week washout period. All patients were followed up for another 3 weeks for safety evaluations. The primary outcome was the magnitude of the change in serum potassium levels. The secondary outcomes were electrocardiography (ECG) changes and treatment safety (volume overload, electrolyte imbalance). Compared with the control group, Ca-PS treatment significantly reduced serum potassium levels (P <0.01). More patients in the Ca-PS group had lower serum potassium levels than the safety level of <5.5 mmol/L (32% for control vs. 61% for Ca-PS, P <0.01). Peaked T-wave occurred less frequently in patients in the Ca-PS group (13.8% for Ca-PS vs. 31.03% for control, P <0.01). In addition, Ca-PS reduced serum phosphorus levels with no effects on serum levels of calcium and sodium, fluid volume, blood pressure, or interdialytic weight gain. Ca-PS treatment decreases serum levels of potassium and phosphorus in MHD patients with interdialytic hyperkalemia. Ca-PS does not induce volume overload or disrupt electrolyte balance.

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Dose-response to a jelly preparation of calcium polystyrene sulfonate in patients with hyperkalemia changes in serum potassium levels with or without a RAAS inhibitor

Cited by 9 publications

References 0 publications

Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients

Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients

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

Calcium–Polystyrene Sulfonate Decreases Inter‐Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study

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Dose-response to a jelly preparation of calcium polystyrene sulfonate in patients with hyperkalemia  changes in serum potassium levels with or without a RAAS inhibitor

Cited by 9 publications

References 0 publications

Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients

Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients

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

Calcium–Polystyrene Sulfonate Decreases Inter‐Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study

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Dose-response to a jelly preparation of calcium polystyrene sulfonate in patients with hyperkalemia changes in serum potassium levels with or without a RAAS inhibitor