Schaefer Jared A, Gales Mark A
Integris Baptist Medical Center, Oklahoma City, OK, USA
Integris Baptist Medical Center, Oklahoma City, OK, USA Sounthwestern Oklahoma State University College of Pharmacy, Weatherford, OK, USA.
Ann Pharmacother. 2016 Jun;50(6):502-10. doi: 10.1177/1060028016640794. Epub 2016 Mar 23.
To evaluate safety and efficacy data for potassium-binding resins in renin-angiotensin-aldosterone system (RAAS)-associated hyperkalemia.
A search of MEDLINE (EBSCOhost; 1946 to February 2016) was conducted using the terms hyperkalemia, rennin-angiotensin-aldosterone system, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, aldosterone antagonists, resin, and binder Results were limited to human trials in English language journals. References of identified articles were reviewed to identify other relevant articles.
Concurrent potassium-binding agents and RAAS inhibitor use literature were reviewed. Inclusion criteria a 2-week minimum therapy duration with hyperkalemia or high-risk patients receiving concurrent RAAS-inhibiting agents. Seven articles met inclusion criteria: 1 retrospective case series for sodium polystyrene sulfonate (SPS), 1 noncontrolled study using patiromer, and 5 randomized, placebo-controlled trials using 3 different agents-2 patiromer, 2 sodium zirconium cyclosilicate (SZC), and 1 cross-linked polyelectrolyte (CLP).
SPS efficacy data are limited to a mean potassium reduction of 1.8 mEq/L in a 14-patient uncontrolled case series. CLP did not reduce hyperkalemia incidence compared with placebo. Patiromer effectively maintained potassium at 0.45 to 0.72 mmol/L lower than placebo while allowing spironolactone dose titration in more patients (91% vs 74%, P = 0.019). SZC also safely and effectively normalized and maintained potassium levels in patients receiving RAAS inhibitors (71%-85% vs 48% for placebo, P < 0.01).
Currently, the literature does not support SPS and CLP for preventing RAAS inhibitor-associated hyperkalemia. Patiromer and SZC safely and effectively lower serum potassium and prevent hyperkalemia redevelopment in patients receiving RAAS inhibitors for up to 4 and 8 weeks,0 respectively.
评估钾结合树脂在肾素-血管紧张素-醛固酮系统（RAAS）相关高钾血症中的安全性和有效性数据。
使用高钾血症、肾素-血管紧张素-醛固酮系统、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、醛固酮拮抗剂、树脂和结合剂等术语对MEDLINE（EBSCOhost；1946年至2016年2月）进行检索。结果仅限于英文期刊上的人体试验。对已识别文章的参考文献进行审查以识别其他相关文章。
对同时使用钾结合剂和RAAS抑制剂的文献进行了审查。纳入标准为高钾血症患者或接受RAAS抑制剂的高危患者至少进行2周的治疗。七篇文章符合纳入标准：1篇关于聚苯乙烯磺酸钠（SPS）的回顾性病例系列，1篇使用帕替罗姆的非对照研究，以及5篇使用3种不同药物的随机、安慰剂对照试验——2种帕替罗姆、2种环硅酸锆钠（SZC）和1种交联聚电解质（CLP）。
SPS的有效性数据仅限于一个14例患者的非对照病例系列中平均血钾降低1.8 mEq/L。与安慰剂相比，CLP并未降低高钾血症的发生率。帕替罗姆有效地将血钾维持在比安慰剂低0.45至0.72 mmol/L的水平，同时允许更多患者进行螺内酯剂量滴定（91%对74%，P = 0.019）。SZC也安全有效地使接受RAAS抑制剂的患者血钾水平正常化并维持在正常水平（71%-85%对安慰剂的48%，P < 0.01）。
目前，文献不支持使用SPS和CLP预防RAAS抑制剂相关的高钾血症。帕替罗姆和SZC可安全有效地降低血清钾水平，并分别在接受RAAS抑制剂的患者中长达4周和8周预防高钾血症的复发。
