The 4 main potassium binders all have short-term efficacy in lowering serum potassium in patients with chronic kidney disease (CKD) and hyperkalemia, a new study finds.
Citing a lack of head-to-head comparisons, investigators compared the potassium binders indirectly using data from 13 randomized controlled trials (RCTs) involving 2150 patients with CKD and hyperkalemia. The control condition was placebo in 11 trials and sodium polystyrene sulfonate (SPS) in 2 trials.
In the systematic review and network meta-analysis, SPS had the most significant potassium-lowering effect, with a mean difference of -0.94, followed by calcium polystyrene sulfonate (CPS, mean difference: -0.46), patiromer (mean difference: -0.41), and sodium zirconium cyclosilicate (SZC, mean difference: -0.37), Lingqiu Dong, MD, and colleagues from West China Hospital, Sichuan University, reported in the European Journal of Pharmacology. A surface under the cumulative ranking curve analysis showed a 92.6% probability that SPS had the best potassium-lowering effect within 2 weeks. After 2 weeks, both SPS and SZC showed efficacy. A SPS dose of 30 g/d appeared to reduce serum potassium better than a 15 g/d dose. A larger dose of SZC (median dose: 6–10 g/d; large dose: more than 10 g/d), also possibly led to more potassium-lowering.
Patients treated with patiromer, SPS, and CPS appeared to have the lowest mortality, the investigators reported.
Patiromer was most likely to cause constipation, nausea, and vomiting. CPS appeared to reduce vomiting. SPS caused diarrhea. Previous observational research indicates, however, that SPS use increases the risk of gastrointestinal events, and even fatal events in the dialysis population, although these studies did not discuss dose.
“These four potassium binders had their own advantages and disadvantages, and the medication should be selected according to the clinical situation of the patient,” Dr Dong’s team concluded.
The trials differed in the potassium binder studied and dose. They often had a short duration and small cohort size. Safety data reporting also was not consistent. For these reasons, additional high-quality data are needed.
Dong L, Xu W, Deng Y, Tan J, Qin W. Efficacy and safety of potassium binders in the treatment of patients with chronic kidney disease and hyperkalemia. Eur J Pharmacol. Published online August 12, 2022. doi:10.1016/j.ejphar.2022.175174