Batterink Josh, Lin Jane, Au-Yeung Sarah Hin Mui, Cessford Tara
BSc(Pharm), ACPR, is with the Pharmacy, St Paul's Hospital, Vancouver, British Columbia.
BSc(Pharm), was, at the time this study was conducted, a student in the Bachelor of Pharmacy program, The University of British Columbia, Vancouver, British Columbia. She is now with the Pharmacy, Nanaimo Regional General Hospital (Island Health), Nanaimo, British Columbia.
Can J Hosp Pharm. 2015 Jul-Aug;68(4):296-303. doi: 10.4212/cjhp.v68i4.1469.
Sodium polystyrene sulfonate (SPS) is a potassium-binding resin that is commonly used to treat mild hyperkalemia. However, there is limited evidence supporting its effectiveness in the short-term management of hyperkalemia.
To determine whether SPS is effective in reducing serum potassium in general medical patients after a single oral dose.
A retrospective observational study was conducted for patients admitted to the internal medicine service of a tertiary care hospital between January 2011 and May 2012 with documentation of a serum potassium level between 5.0 and 5.9 mmol/L during the hospital stay. Patients eligible for inclusion were adults without chronic or acute renal failure or recent changes in medication or diet that would affect serum potassium level. Propensity score matching was performed to minimize differences between the control group (no treatment) and the treatment group (treatment with oral SPS). Follow-up serum potassium levels (at 6-24 h) were compared with index potassium levels.
A total of 138 patients met the inclusion criteria, 72 in the control group and 66 in the treatment group. For most patients in the treatment group, the dose was 15 or 30 g of SPS orally. The difference between the control and treatment groups in terms of mean change in serum potassium at 6 to 24 h after the index potassium measurement was statistically significant (by paired t test) in both an unmatched analysis (-0.41 ± 0.50 and -0.58 ± 0.39 mmol/L, respectively; p = 0.039) and a matched analysis (-0.44 ± 0.29 and -0.58 ± 0.39 mmol/L, respectively; p = 0.026). No difference was observed in terms of mean change in serum potassium between patients who received 15 and 30 g of SPS (-0.51 ± 0.38 and -0.66 ± 0.40 mmol/L, respectively; p = 0.13).
In patients with mild hyperkalemia, oral SPS therapy reduced serum potassium by 0.14 mmol/L more than control. Although this difference was statistically significant, the small treatment effect observed in this study may not be clinically important. Furthermore, the cost and potential adverse effects of treatment suggest that routine use of SPS may be inappropriate for patients with mild hyperkalemia. Prospective randomized controlled trials would help in further evaluating the effectiveness and safety of SPS.
聚苯乙烯磺酸钠（SPS）是一种钾结合树脂，常用于治疗轻度高钾血症。然而，支持其在高钾血症短期治疗中有效性的证据有限。
确定单次口服SPS对普通内科患者降低血清钾水平是否有效。
对2011年1月至2012年5月入住一家三级护理医院内科且住院期间血清钾水平记录在5.0至5.9 mmol/L之间的患者进行回顾性观察研究。纳入标准为无慢性或急性肾衰竭、近期无影响血清钾水平的药物或饮食变化的成年人。进行倾向评分匹配以尽量减少对照组（未治疗）和治疗组（口服SPS治疗）之间的差异。将随访血清钾水平（6 - 24小时）与初始钾水平进行比较。
共有138例患者符合纳入标准，对照组72例，治疗组66例。治疗组大多数患者口服SPS的剂量为15或30克。在未匹配分析（分别为-0.41±0.50和-0.58±0.39 mmol/L；p = 0.039）和匹配分析（分别为-0.44±0.29和-0.58±0.39 mmol/L；p = 0.026）中，对照组和治疗组在初始钾水平测量后6至24小时血清钾平均变化方面的差异均具有统计学意义（通过配对t检验）。接受15克和30克SPS的患者在血清钾平均变化方面未观察到差异（分别为-0.51±0.38和-0.66±0.40 mmol/L；p = 0.13）。
在轻度高钾血症患者中，口服SPS治疗比对照组多降低血清钾0.14 mmol/L。尽管这种差异具有统计学意义，但本研究中观察到的小治疗效果可能在临床上并不重要。此外，治疗的成本和潜在不良反应表明，对于轻度高钾血症患者常规使用SPS可能不合适。前瞻性随机对照试验将有助于进一步评估SPS的有效性和安全性。
