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Hypercalcemia as a side effect of potassium binding agents.

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  • 1Servicio de Nefrología, Hospital Universitari Doctor Josep Trueta, Girona, Spain. dvdrry@gmail.com

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Summary

Calcium-containing resins used for hyperkalemia in chronic kidney disease (CKD) can cause mild hypercalcemia. Monitoring calcium levels is crucial for CKD patients on these medications to prevent adverse effects.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Pharmacology

Background:

  • Hypercalcemia is a known risk associated with calcium-containing ion exchange resins.
  • These resins are frequently prescribed for managing hyperkalemia in patients with chronic kidney disease (CKD).

Purpose of the Study:

  • To investigate the occurrence and characteristics of mild hypercalcemia in outpatients with moderate CKD treated with calcium polystyrene sulfonate.
  • To assess the impact of calcium polystyrene sulfonate on serum calcium and intact parathormone (iPTH) levels in this patient group.

Main Methods:

  • Retrospective case series of seven outpatients with moderate CKD.
  • Monitoring of serum calcium and iPTH levels before and after treatment adjustment (withdrawal or dose reduction) of calcium polystyrene sulfonate.

Main Results:

  • Seven outpatients with moderate CKD (eGFR 41.29 ± 10.83 mL/min/1.73 m(2)) developed mild hypercalcemia during treatment with calcium polystyrene sulfonate.
  • Mean serum calcium increased by 0.91 ± 0.46 mg/dL, accompanied by a mean iPTH decrease of 52.24 ± 49.29 ng/dL.
  • Serum calcium and iPTH levels normalized after discontinuing or reducing the dose of the resin.

Conclusions:

  • Calcium polystyrene sulfonate can induce mild hypercalcemia in patients with moderate CKD.
  • Calcium-containing potassium binders should be considered in the differential diagnosis of hypercalcemia in CKD patients.
  • Monitoring serum calcium is essential for patients with CKD receiving calcium-based potassium binders.