Sodium Polystyrene for Hyperkalemia and Serious GI Events

Written by Vivian Lei

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In this large population-based study, sodium polystyrene sulfonate (SPS) use in elderly outpatients was associated with an almost 2-fold higher risk of serious adverse GI events within 30 days of initial prescription. The absolute risk increase was small, however.

Why does this matter?
SPS (brand name Kayexalate) is commonly prescribed for treatment of hyperkalemia, but prior case reports raise concern for serious GI injuries. This large population-based cohort study found a small but significantly increased risk of intestinal ischemia or thrombosis within 30 days of SPS prescription. When other options for treating hyperkalemia exist, should we really still be using this medication?

A terrible gut reaction
This was a Canadian retrospective population-based cohort study of over 20,000 patients over age 65 who received a first time prescription of SPS. The primary outcome was hospitalization or emergency department visit for adverse GI events, including intestinal ischemia/thrombosis, GI ulceration/perforation, or resection/ostomy within 30 days of initial SPS prescription. Compared to a propensity-matched cohort of similar patients who did not receive this medication, the study found 37 (0.2%) adverse GI events in the SPS group compared to 18 (0.1%) in the non-use group during the 30 day follow-up period, a significant difference with a hazard ratio of 1.94 (95% CI 1.10 – 3.41). Intestinal ischemia/thrombosis was the most common type of GI injury.

Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age. JAMA Intern Med. 2019 Jun 10. doi: 10.1001/jamainternmed.2019.0631. [Epub ahead of print]

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Reviewed by Thomas Davis

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