983: ACUTE HYPERKALEMIA: SODIUM ZIRCONIUM CYCLOSILICATE COMPARED TO SODIUM POLYSTYRENE SULFONATE

Maintaining potassium balance in the body is essential for cellular function. Even a slight increase in normal serum potassium levels (3.5-5.0 mEq/L) can interfere with metabolism, electrical action potentials, and cellular processes. Hyperkalemia is commonly seen in patients with chronic kidney disease (CKD) and in patients on renin–angiotensin–aldosterone system (RAAS) inhibitors. Sodium polystyrene sulfonate (SPS), diuretics, and hemodialysis are currently available methods for removing potassium from the body; however, these options have their limitations. Patiromer (Veltassa) and sodium zirconium cyclosilicate are 2 new therapeutic options that can potentially lead a new frontier in the management of hyperkalemia. This article will review these novel treatments.

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A Case of Fatal Intestinal Infarct Preceded by Recurrent Ischaemic Colitis due to the Enterotoxic Effect of Sodium Polystyrene Sulfonate

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_001973 ◽

2021 ◽

Author(s):

Renato De Vecchis ◽

Andrea Paccone

Keyword(s):

Low Dose ◽

Exchange Resin ◽

Cation Exchange Resin ◽

Sodium Polystyrene Sulfonate ◽

Polystyrene Sulfonate ◽

Ischaemic Colitis ◽

Intestinal Infarction ◽

Biopsy Specimens ◽

Sodium Zirconium ◽

Sodium Zirconium Cyclosilicate

Case description: A 64-year-old patient with chronic renal failure and persistent hyperkalaemia not corrected by dialysis, was prescribed sodium polystyrene sulfonate (SPS) at a low dose (30 g/day for 2 days a week during the long interdialytic interval). After 3 months of therapy, the patient developed intense abdominal pain with non-specific colitis identified with a colonoscopy. In addition, the biopsy specimens showed rhomboid SPS crystals in the intestinal mucosa. Fourteen months after discontinuing therapy, the patient again presented with colitis and persistent biopsy finding of SPS crystals. The patient died a few months later due to intestinal infarction. Discussion and conclusion: SPS is a cation exchange resin used to treat hyperkalaemia resistant to dialysis, but may cause inflammation and ischaemia of the colon. In our patient, a short 3-month course of low-dose SPS therapy (without sorbitol, which is used to counter iatrogenic constipation caused by SPS) induced relapsing colitis, which was followed by massive intestinal infarction a few months later. In light of frequent reports of its enterotoxic effects, SPS should be replaced with the new potassium chelators (patiromer and sodium zirconium cyclosilicate).

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Clinical utility of patiromer, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate for the treatment of hyperkalemia: an evidence-based review [Erratum]

Core Evidence ◽

10.2147/ce.s205026 ◽

2019 ◽

Vol Volume 14 ◽

pp. 1-2

Author(s):

Mario Beccari ◽

Calvin Meaney

Keyword(s):

Clinical Utility ◽

Sodium Polystyrene Sulfonate ◽

Evidence Based ◽

Polystyrene Sulfonate ◽

Sodium Zirconium ◽

Sodium Zirconium Cyclosilicate

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New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Journal of Clinical Medicine ◽

10.3390/jcm9082337 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2337 ◽

Cited By ~ 2

Author(s):

Pasquale Esposito ◽

Novella Evelina Conti ◽

Valeria Falqui ◽

Leda Cipriani ◽

Daniela Picciotto ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Therapeutic Option ◽

Treatment Options ◽

New Drugs ◽

Sodium Polystyrene Sulfonate ◽

Sodium Zirconium ◽

Life Threatening ◽

New Treatment ◽

Sodium Zirconium Cyclosilicate

Hyperkalemia may cause life-threatening cardiac and neuromuscular alterations, and it is associated with high mortality rates. Its treatment includes a multifaceted approach, guided by potassium levels and clinical presentation. In general, treatment of hyperkalemia may be directed towards stabilizing cell membrane potential, promoting transcellular potassium shift and lowering total K+ body content. The latter can be obtained by dialysis, or by increasing potassium elimination by urine or the gastrointestinal tract. Until recently, the only therapeutic option for increasing fecal K+ excretion was represented by the cation-exchanging resin sodium polystyrene sulfonate. However, despite its common use, the efficacy of this drug has been poorly studied in controlled studies, and concerns about its safety have been reported. Interestingly, new drugs, namely patiromer and sodium zirconium cyclosilicate, have been developed to treat hyperkalemia by increasing gastrointestinal potassium elimination. These medications have proved their efficacy and safety in large clinical trials, involving subjects at high risk of hyperkalemia, such as patients with heart failure and chronic kidney disease. In this review, we discuss the mechanisms of action and the updated data of patiromer and sodium zirconium cyclosilicate, considering that the availability of these new treatment options offers the possibility of improving the management of both acute and chronic hyperkalemia.

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