Abstract

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.

Highlights

  • We enrolled a total of 247 adult patients with a basal Estimated glomerular filtration rate (eGFR) level of 30 ± 15 mL/min/1.73 m2

  • No serious adverse effects were reported during Calcium polystyrene sulfonate (CPS) administration, though constipation was noted in 19 patients (8%)

  • Hyperkalemia is an important complication of chronic kidney disease (CKD) because urinary potassium excretion gradually decreases with declining glomerular filtration rate (GFR) [1]

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Summary

Introduction

Hyperkalemia is an important complication of chronic kidney disease (CKD) because urinary potassium excretion gradually decreases with declining glomerular filtration rate (GFR) [1]. Hyporeninemic hypoaldosteronism and angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blockade (ARB) therapy increase the risk of hyperkalemia in CKD patients [2]. This is the major obstacle to the use of ACEIs and ARBs as renoprotective agents. Patients with diabetic kidney disease may benefit from potassium lowering agents because hyperkalemia is difficult to be avoided by dietary potassium restriction alone. Calcium polystyrene sulfonate (CPS) has long been used to treat hyperkalemia in patients with chronic kidney disease (CKD).

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