Ren Hongru, Leon Silvia J, Whitlock Reid, Rigatto Claudio, Komenda Paul, Bohm Clara, Collister David, Tangri Navdeep
Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Clin Kidney J. 2022 Mar 21;15(9):1713-1719. doi: 10.1093/ckj/sfac077. eCollection 2022 Sep.
Sodium and calcium polystyrene sulfonate (SPS/CPS) cation-exchange resins have had long-standing clinical use for hyperkalemia in patients with chronic kidney disease (CKD). However, uncertainty exists regarding the real-world usage of SPS/CPS for acute and chronic management of hyperkalemia. We evaluated the prescription patterns of SPS/CPS and their impact on renin-angiotensin-aldosterone system inhibitor (RAASi) treatment in patients with CKD Stages G3-G5 after an episode of hyperkalemia.
We conducted a retrospective cohort study using population-level administrative databases in Manitoba, Canada, which included adults with CKD and a RAASi prescription who had an episode of hyperkalemia (≥5.5 mmol/L) between January 2007 and December 2017.
A total of 10 009 individuals were included in our study cohort. Among the study population, 4% received an SPS/CPS prescription within 30 days of their hyperkalemia episode. Of those, 22% received a 1-day supply of SPS/CPS and 7% received a prescription for more than 30 days. There were 8145 patients using RAASi at baseline who survived 90 days after their first hyperkalemia episode. Of those, 1447 (18%) discontinued their RAAS inhibitor and 339 (5%) received a prescription of SPS/CPS. Also, the proportion of patients who discontinued their RAASi was similar among those who did and did not receive a prescription of SPS/CPS.
In patients with CKD receiving RAASi therapy, there is a low frequency of SPS/CPS prescription after an episode of hyperkalemia. RAASi discontinuation or downtitration is the most used pharmacologic approach for the management of hyperkalemia, a strategy that deprives patients of the cardiac and renal protective benefits of RAASi. New options for the management of hyperkalemia in this population are needed.
聚苯乙烯磺酸钠和聚苯乙烯磺酸钙（SPS/CPS）阳离子交换树脂长期以来一直用于慢性肾脏病（CKD）患者的高钾血症治疗。然而，SPS/CPS在高钾血症急性和慢性管理中的实际应用仍存在不确定性。我们评估了CKD 3 - 5期患者在发生高钾血症后SPS/CPS的处方模式及其对肾素 - 血管紧张素 - 醛固酮系统抑制剂（RAASi）治疗的影响。
我们使用加拿大曼尼托巴省的人群水平管理数据库进行了一项回顾性队列研究，研究对象包括2007年1月至2017年12月期间患有CKD且正在服用RAASi并发生高钾血症（≥5.5 mmol/L）的成年人。
我们的研究队列共纳入10009人。在研究人群中，4%在高钾血症发作后30天内接受了SPS/CPS处方。其中，22%接受了1天剂量的SPS/CPS，7%接受了超过30天的处方。有8145例患者在基线时使用RAASi，在首次高钾血症发作后存活90天。其中，1447例（18%）停用了RAAS抑制剂，339例（5%）接受了SPS/CPS处方。此外，在接受和未接受SPS/CPS处方的患者中，停用RAASi的患者比例相似。
在接受RAASi治疗的CKD患者中，高钾血症发作后SPS/CPS处方频率较低。停用RAASi或降低其剂量是治疗高钾血症最常用的药物方法，这种策略使患者无法获得RAASi对心脏和肾脏的保护益处。该人群需要新的高钾血症管理方案。
