Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Eur J Pharmacol. 2022 Sep 15;931:175174. doi: 10.1016/j.ejphar.2022.175174. Epub 2022 Aug 12.
Gastrointestinal cation exchangers that can bind potassium in the gut, including sodium polystyrene sulfonate (SPS), calcium polystyrene sulfonate (CPS), patiromer and sodium zirconium cyclosilicate (SZC), are emerging medications for the treatment of hyperkalemia with chronic kidney disease (CKD). However, which might be the best alternative for patients with chronic kidney disease and hyperkalemia remains disputed.
We performed this systematic review and network meta-analysis with the Bayesian approach to conduct direct and indirect comparisons among potassium binders regarding their efficacy and safety. The surface under the cumulative ranking curve analysis (SUCRA) was used to calculate the best intervention for each outcome.
All four potassium binders had a promising effect regarding potassium reduction. SPS had favorable efficacy and safety for short-term use (MD: -0.94; 95% CIs: -1.4 to -0.48; SUCRA = 94.69%), but long-term treatment required strict dose control and assessment of gastrointestinal conditions. CPS had a positive effect on reducing potassium, and could especially maintain the serum potassium concentration in patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi). Patiromer might reduce all-cause mortality in CKD patients with hyperkalemia and have a positive effect on potassium-lowering, though it had significant gastrointestinal adverse effects. SZC had a potassium-lowering effect in both the short-term and long-term, and can be a promising long-term treatment for the hyperkalemia in CKD patients, especially in combination with RAASi.
These four potassium binders had their own advantages and disadvantages, and the medication should be selected according to the clinical situation of the patient.
胃肠道阳离子交换剂可在肠道内结合钾，包括聚苯乙烯磺酸纳（SPS）、聚苯乙烯磺酸钙（CPS）、帕立骨化醇和硅酸锆钠（SZC），这些药物正逐渐成为治疗慢性肾脏病（CKD）高钾血症的药物。然而，对于 CKD 伴高钾血症患者，哪种药物是最佳替代药物仍存在争议。
我们采用贝叶斯方法进行了这项系统评价和网络荟萃分析，以比较钾结合剂在疗效和安全性方面的直接和间接比较。采用累积排序曲线下面积分析（SUCRA）计算每个结局的最佳干预措施。
所有四种钾结合剂在降低血钾方面均有良好的效果。SPS 在短期使用时具有良好的疗效和安全性（MD：-0.94；95%置信区间：-1.4 至-0.48；SUCRA=94.69%），但长期治疗需要严格控制剂量并评估胃肠道情况。CPS 对降低血钾有积极作用，尤其能维持接受肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗的患者的血清钾浓度。帕立骨化醇可能降低 CKD 伴高钾血症患者的全因死亡率，且对降低血钾有积极作用，但有显著的胃肠道不良反应。SZC 在短期和长期均有降低血钾的作用，在与 RAASi 联合使用时，可能是 CKD 高钾血症患者有前途的长期治疗药物。
这四种钾结合剂各有优缺点，应根据患者的临床情况选择药物。
