帕替罗姆和环硅酸锆钠治疗高钾血症：一项系统评价和荟萃分析
Patiromer and Sodium Zirconium Cyclosilicate in Treatment of Hyperkalemia: A Systematic Review and Meta-Analysis.
作者信息
Shrestha Dhan Bahadur, Budhathoki Pravash, Sedhai Yub Raj, Baniya Ramkaji, Cable Casey A, Kashiouris Markos G, Dixon Dave L, Kidd Jason M, Adhikari Yuvraj, Marasini Anupama, Bhandari Shakar
机构信息
Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois.
Department of Internal Medicine, Bronxcare Health System, New York, NY.
出版信息
Curr Ther Res Clin Exp. 2021 Jul 5;95:100635. doi: 10.1016/j.curtheres.2021.100635. eCollection 2021.
BACKGROUND
Patiromer and sodium zirconium cyclosilicate (SZC) are newer options for hyperkalemia treatment. This systematic review and meta-analysis were conducted to assess the safety and side effect profile of patiromer and SZC compared with placebo or other standards of care in the management of hyperkalemia.
METHODS
We searched electronic databases for relevant articles. The screening was performed independently and data were extracted among the selected studies. We performed a statistical analysis on Revman 5.4 software. The odds ratio (OR) was used for outcome estimation with a 95% CI.
RESULTS
Patiromer had lower rates of hyperkalemia (OR = 0.44; 95% CI, 0.22-0.89) compared with standard of care. The analysis showed no significant differences between the 2 groups in terms of overall adverse effects, any serious/specific adverse effects, or treatment discontinuation as a result of adverse effects. Comparing the SZC-10 group with standard of care showed no significant differences in the occurrence of hyperkalemia during treatment, overall adverse effects, any serious/specific adverse effects, or treatment discontinuation as a result of adverse effects but showed a higher rate of edema in the treatment group (OR = 6.77; 95% CI, 1.03-44.25). Similarly, no significant differences were seen between the 2 SZC doses for the occurrence of any adverse effects, hyperkalemia, constipation, diarrhea, or urinary tract infection, whereas edema was higher among patients receiving SZC-10 (OR = 3.13; 95% CI, 1.19-8.27).
CONCLUSIONS
In patients with acute hyperkalemia, SZC is the drug of choice due to its more rapid reduction of serum potassium level, whereas in patients with chronic hyperkalemia, patiromer appears to be the drug of choice because SZC is associated with an increase in edema, likely due to an increase in sodium absorption, which could have important adverse consequences in patients with chronic kidney disease and or heart failure. Thus, both drugs were found to be safe while treating hyperkalemia. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).
背景
帕替罗姆和环硅酸锆钠（SZC）是治疗高钾血症的新选择。本系统评价和荟萃分析旨在评估与安慰剂或其他高钾血症管理的标准治疗相比，帕替罗姆和SZC的安全性和副作用情况。
方法
我们在电子数据库中检索相关文章。筛选工作独立进行，并在选定研究中提取数据。我们使用Revman 5.4软件进行统计分析。采用比值比（OR）进行结局估计，95%置信区间（CI）。
结果
与标准治疗相比，帕替罗姆导致高钾血症的发生率较低（OR = 0.44；95% CI，0.22 - 0.89）。分析显示，两组在总体不良反应、任何严重/特定不良反应或因不良反应导致的治疗中断方面无显著差异。将SZC - 10组与标准治疗相比，治疗期间高钾血症的发生率、总体不良反应、任何严重/特定不良反应或因不良反应导致的治疗中断方面无显著差异，但治疗组水肿发生率较高（OR = 6.77；95% CI，1.03 - 44.25）。同样，两种SZC剂量在任何不良反应、高钾血症、便秘、腹泻或尿路感染的发生率方面无显著差异，而接受SZC - 10治疗的患者水肿发生率较高（OR = 3.13；95% CI，1.19 - 8.27）。
结论
在急性高钾血症患者中，SZC因其能更快降低血清钾水平而成为首选药物；而在慢性高钾血症患者中，帕替罗姆似乎是首选药物，因为SZC与水肿增加有关，这可能是由于钠吸收增加所致，这在慢性肾病和/或心力衰竭患者中可能会产生重要的不良后果。因此，两种药物在治疗高钾血症时均被发现是安全的。（《当前治疗研究与临床实验》。2021年；82卷：XXX - XXX）
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