Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.
Department of Nephrology, Houston Methodist Hospital, Houston, TX, USA.
Am J Health Syst Pharm. 2023 Sep 7;80(18):1238-1246. doi: 10.1093/ajhp/zxad137.
Potassium binders are frequently utilized for the treatment of hyperkalemia in hospitalized patients; however, there is limited data directly comparing individual agents. The purpose of this study was to compare the effectiveness and safety of sodium polystyrene sulfonate (SPS) and sodium zirconium cyclosilicate (SZC) for hyperkalemia treatment in hospitalized patients.
This retrospective cohort study evaluated adult patients who were admitted within a 7-hospital health system and received SPS or SZC for a serum potassium level greater than 5.0 mEq/L. Patients receiving dialysis prior to SPS/SZC administration, those receiving other potassium-lowering medications within 6 hours prior to blood sampling for a repeat potassium level, and those started on kidney replacement therapy prior to sampling for a repeat potassium level were excluded.
Following evaluation of 3,903 patients, the mean reduction in serum potassium 4 to 24 hours after binder administration was 0.96 mEq/L with SPS and 0.78 mEq/L with SZC (P < 0.0001). The median dose of SPS was 30 g (interquartile range [IQR], 15-30 g) while the median (IQR) dose of SZC was 10 g (10-10 g). Resolution of hyperkalemia within 24 hours was achieved in a higher percentage of patients with use of SPS (74.9%) versus SZC (68.8%) (P < 0.001).
One of the largest comparisons of SPS and SZC conducted to date, this study demonstrated the effectiveness and safety of both agents. While a statistically greater reduction in serum potassium was observed with use of SPS, there was significant dosing variability among agents that limited the ability to directly compare specific doses. Further investigation is needed to determine the optimal dose of each agent for acute hyperkalemia management. This data will inform clinical decisions about the choice of potassium binder for acute hyperkalemia.
在住院患者中，经常使用钾结合剂来治疗高钾血症；然而，直接比较不同药物的疗效的数据非常有限。本研究旨在比较聚苯乙烯磺酸钙（SPS）和硅酸锆酸钠（SZC）治疗住院患者高钾血症的疗效和安全性。
本回顾性队列研究评估了在一个 7 家医院医疗系统内住院且血清钾水平>5.0 mEq/L 的成年患者。排除了在 SPS/SZC 给药前接受透析、在重复血钾检测前 6 小时内接受其他降钾药物治疗、以及在重复血钾检测前开始肾脏替代治疗的患者。
在评估了 3903 例患者后，SPS 治疗后 4 至 24 小时血清钾的平均降低量为 0.96 mEq/L，SZC 为 0.78 mEq/L（P<0.0001）。SPS 的中位剂量为 30 g（四分位距 [IQR]，15-30 g），SZC 的中位（IQR）剂量为 10 g（10-10 g）。使用 SPS 治疗后 24 小时内高钾血症缓解的患者比例高于 SZC（74.9% vs. 68.8%）（P<0.001）。
这是迄今为止对 SPS 和 SZC 进行的最大规模比较之一，本研究证明了这两种药物的有效性和安全性。虽然使用 SPS 观察到血清钾降低的幅度更大，但由于各药物剂量存在显著差异，限制了直接比较特定剂量的能力。需要进一步研究来确定每种药物在急性高钾血症管理中的最佳剂量。该数据将为急性高钾血症管理中钾结合剂的选择提供临床决策依据。
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