SHORT TERM TREATMENT OF CHRONIC HYPERKALEMIA WITH ORAL POTASSIUM BINDER IN CHRONIC KIDNEY DISEASE PATIENTS

Sabir Sulejman; Angela Karanfilovik; Ana Stojanoska; Mimoza Milenkova; Julijana Usprcov; Bleron Kolonja; Izet Salkoski; Hristina Minovska; Adrian Memeti; Adrijana Spasovska; Oliver Ristevski

Sabir Sulejman Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Angela Karanfilovik Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Ana Stojanoska Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Mimoza Milenkova Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Julijana Usprcov Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Bleron Kolonja Specialized Hospital of Nephrology, Struga,North Macedonia
Izet Salkoski Specialized Hospital of Nephrology, Struga, North Macedonia
Hristina Minovska Department of Internal Medicine, Clinic hospital Dr. Trifun Panovski Bitola, North Macedonia
Adrian Memeti Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Adrijana Spasovska Clinic of Nephrology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Oliver Ristevski Department of Internal Medicine, General City Hospital , Skopje, North Macedonia

Abstract

The aim of our study was to analyse the efficacy of short-term administration of oral calcium polystyrene sulfonate (CPS) to treat hyperkalemia in non-dialysis CKD patients. A prospective interventional study was conducted in 65 CKD patients with chronic hyperkalemia with a month of therapy. Patients were stratified into groups in respect of potassium level (mild <5.9; moderate 6-6.5; severe â‰¥6.5 mmol/l). Regression analysis was applied to investigate associations of hyperkalemia with different variables. Paired T-Test was used for comparative analysis of potassium levels before and after therapy. Patients mean age was 67 years, eGFR ranged between 8 to 52ml/min. More than half of patients presented with moderate or severe hyperkalemia.None of the demographic, clinical or pharmacological variables predicted potassium level. The comparative analysis with paired samples T-Test showed significantly lower potassium levels after one month of therapy (p<0.001). The portion of patients that were encountered for mild hyperkalemia significantly increased (21% vs. 59%, p<0.001) and conversely, the portions of those with moderate and severe hyperkalemia significantly decreased (29% vs. 3%, p<0.001; 15% vs, 3%, p<0.001), respectively. Short term treatment of hyperkalemia with oral potassium binder is effective in non-dialysis CKD patients.

Key words: hyperkalemia, potassium binder, CKD, GFR, RAAS therapy.

References

1.De Nicola L, Di Lullo L, Paoletti E, Cupisti A, Bianchi S. Chronic hyperkalemia in non-dialysis CKD: controversial issues in nephrology practice. J Nephrol. 2018 Oct;31(5):653-664. doi: 10.1007/s40620-018-0502-6. Epub 2018 Jun 7. PMID: 29882199; PMCID: PMC6182350.
2. Muneer K, Nair A. Angiotensin-converting enzyme inhibitors and receptor blockers in heart failure and chronic kidney disease - Demystifying controversies. Indian Heart J. 2017 May-Jun;69(3):371-374. doi: 10.1016/j.ihj.2016.08.007. Epub 2016 Sep 8. PMID: 28648436; PMCID: PMC5485404.
3. Clegg DJ, Headley SA, Germain MJ. Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet. Kidney Med. 2020 Jun 15;2(4):476-487. doi: 10.1016/j.xkme.2020.04.007. PMID: 32775988; PMCID: PMC7406842.
4. Kim GH. Pharmacologic Treatment of Chronic Hyperkalemia in Patients with Chronic Kidney Disease. Electrolyte Blood Press. 2019 Jun;17(1):1-6. doi: 10.5049/EBP.2019.17.1.1. Epub 2019 Jun 30. PMID: 31338108; PMCID: PMC6629599.
5. Morales E, Cravedi P, Manrique J. Management of Chronic Hyperkalemia in Patients With Chronic Kidney Disease: An Old Problem With News Options. Front Med (Lausanne). 2021 Jun 4;8:653634. doi: 10.3389/fmed.2021.653634. PMID: 34150795; PMCID: PMC8213200.
6. St-Jules DE, Clegg DJ, Palmer BF, Carrero JJ. Can Novel Potassium Binders Liberate People with Chronic Kidney Disease from the Low-Potassium Diet? A Cautionary Tale. Clin J Am Soc Nephrol. 2022 Mar;17(3):467-472. doi: 10.2215/CJN.09660721. Epub 2021 Oct 20. PMID: 34670798; PMCID: PMC8975039.
7. Valdivielso JM, Carriazo S, Martin M, Fernandez-Fernandez B, Bermudez-LÃ³pez M, Ortiz A; NEFRONA investigators. Gender-specific risk factors and outcomes of hyperkalemia in CKD patients: smoking as a driver of hyperkalemia in men. Clin Kidney J. 2023 Oct 9;17(1):sfad212. doi: 10.1093/ckj/sfad212. PMID: 38186899; PMCID: PMC10768768.
8. Yu MY, Yeo JH, Park JS, Lee CH, Kim GH. Long-term efficacy of oral calcium polystyrene sulfonate for hyperkalemia in CKD patients. PLoS One. 2017 Mar 22;12(3):e0173542. doi: 10.1371/journal.pone.0173542. PMID: 28328954; PMCID: PMC5362098.
9. Wang X, Chen D, Song X, Wang J, Zhang H. Efficacy and safety of calcium polystyrene sulfonate in patients with hyperkalemia and stage 3-5 non-dialysis chronic kidney disease: a single-center randomized controlled trial. J Int Med Res. 2023 Apr;51(4):3000605231167516. doi: 10.1177/03000605231167516. PMID: 37063062; PMCID: PMC10119845.
10. Georgianos PI, Liampas I, Kyriakou A, Vaios V, Raptis V, Savvidis N et al. Evaluation of the tolerability and efficacy of sodium polystyrene sulfonate for long-term management of hyperkalemia in patients with chronic kidney disease. Int Urol Nephrol. 2017 Dec;49(12):2217-2221. doi: 10.1007/s11255-017-1717-5. Epub 2017 Oct 11. PMID: 29027620.
11. Packham DK, Rasmussen HS, Lavin PT, El-Shahawy MA, Roger SD, Block G et al. Sodium zirconium cyclosilicate in hyperkalemia. N Engl J Med. 2015 Jan 15;372(3):222-31. doi: 10.1056/NEJMoa1411487. Epub 2014 Nov 21. PMID: 25415807.
12. Clegg DJ, Headley SA, Germain MJ. Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet. Kidney Med. 2020 Jun 15;2(4):476-487. doi: 10.1016/j.xkme.2020.04.007. PMID: 32775988; PMCID: PMC7406842.