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Abstract: FR-PO649

Compared Effects of Calcium and Sodium Polystyrene Sulfonate on Mineral, Bone Metabolism, and Acid-Base Equilibrium in CKD Patients with Hyperkalemia

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Nakayama, Yosuke, Division of Nephrology,Department of Medicine,Kurume University, Kurume, Japan
  • Kodama, Goh, Division of Nephrology,Department of Medicine,Kurume University, Kurume, Japan
  • Ito, Sakuya, Division of Nephrology,Department of Medicine,Kurume University, Kurume, Japan
  • Fukami, Kei, Division of Nephrology,Department of Medicine,Kurume University, Kurume, Japan
Background

Hyperkalemia is prevalent in end-stage renal disease patients, being involved in life-threatening arrhythmias. Although polystyrene sulfonate (PS) is commonly used for the treatment of hyperkalemia, direct comparison of effects between calcium and sodium PS (CPS and SPS) on mineral, bone metabolism and acid-base equilibrium has not yet been studied.

Methods

This study was designed as a prospective, open-labeled, randomized, and crossover study (n=40). Patients were orally administered CPS (ARGAMATE® 89.29 % GRANULE 5.6 g; powder 5 g) or SPS (KAYEXALATE DRY SYRUP 76%® 6.54 g; powder 5 g) after each meal. After 4 weeks treatment, each PS was immediately switched to another PS without washout interval, and followed-up for further 4 weeks. To investigate the cation-absorption capacity of CPS and SPS, we constructed an artificial colon fluid (ACF) based on the data of human diarrhea as described previously. One gram of CPS or SPS was added into the 50 ml of ACF (n=6, respectively). After filtration, the concentrations of K, Ca, Na, Mg, and NH3 in the supernatant were determined.

Results

After 4 week-treatments, there was no significant difference of changes in serum potassium (K) from the baseline (ΔK) between the two groups. However, SPS significantly decreased serum calcium (Ca) and magnesium (Mg) and increased intact parathyroid hormone (iPTH) values, whereas CPS reduced iPTH. ΔiPTH was inversely correlated with ΔCa and ΔMg (r=-0.53 and r=-0.50, respectively). Furthermore, sodium (Na) and atrial natriuretic peptide (ANP) levels were significantly elevated in patients with SPS, but not with CPS, whereas ΔNa and ΔANP were significantly correlated with each other in all the patients. We also found that SPS, but not CPS treatment significantly increased plasma HCO3- and serum Na levels, while serum NH3 levels were not changed by either PS treatment. ΔNa and Δ(Na to Cl ratio) but not ΔNH3 were positively correlated with ΔHCO3- (r=0.75, p<0.0001, r=0.84, p<0.0001, and r=0.06, p=0.75, respectively). In artificial colon fluid, CPS increased Ca and decreased Na. Furthermore, SPS more decreased K, Mg, and NH3.

Conclusion

Compared with SPS, CPS may be safer for the treatment of hyperkalemia in pre-dialysis patients, because it did not induce hyperparathyroidism or volume overload.

Funding

  • Private Foundation Support