Polysulfonate Resins in Hyperkalemia: A Systematic Review

Area of Science:

• Nephrology
• Internal Medicine
• Clinical Pharmacology

Background:

• Hyperkalemia, a serum potassium level exceeding 5.0-5.5 mEq/L, is a critical condition.
• Sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) are established treatments for hyperkalemia.
• Concerns exist regarding the evidence base and gastrointestinal safety of SPS and CPS.

Purpose of the Study:

• To systematically review and quantify the efficacy and safety of SPS/CPS in treating adult hyperkalemia.
• To analyze randomized controlled trials (RCTs), non-RCTs, and observational data on SPS/CPS use.

Main Methods:

• A systematic review was conducted using data from Medline, EMBASE, and Cochrane Library (1946-2019).
• Included studies focused on adults with hyperkalemia treated with SPS/CPS, encompassing inpatient and outpatient settings.
• Primary outcome was serum potassium change; secondary outcomes included adverse effects and prevention of recurrent hyperkalemia.

Main Results:

• 25 studies (4 RCTs, 21 observational, 5 quasi-experimental) with over 212,000 patients were analyzed.
• 88% of studies showed a serum potassium reduction >0.5 mEq/L.
• High-quality observational studies indicated a potential increased risk of serious gastrointestinal events, though absolute risk remained low.

Conclusions:

• A significant lack of high-quality evidence supports the use of SPS/CPS for hyperkalemia.
• The most robust evidence pertains to chronic hyperkalemia management.
• Evidence for SPS/CPS efficacy in acute hyperkalemia is not well-supported by high-quality data.