![]() ![]() Loop diuretics, such as furosemide, may not work well in patients with chronic kidney disease. On rare occasions, necrosis of the colon may occur with its administration, a complication that has resulted in a black-box warning. "When administered as an enema, it is also unpleasant. The preparation, which is taken by mouth, has a noxious taste and may cause diarrhea," she wrote. "Kayexalate, which was developed in the mid-20th century, requires administration with water, most often with sorbitol added. In an editorial in NEJM, Julie Ingelfinger, MD, of Massachusetts General Hospital, wrote that neither of the current drug therapies for hyperkalemia - Kayexalate nor calcium polystyrene sulfonate - is an "appealing option." "Although this study showed the benefit of patiromer in treating hyperkalemia and in reducing the risk of recurrence and also showed that more patients in the patiromer group than in the placebo group were able to continue taking RAAS inhibitors, additional data evaluating patiromer therapy in the long term are needed," they wrote. Mild-to-moderate constipation was the most common adverse event, and hypokalemia occurred in 3% of patients, they added. Weir and colleagues found that more patients on placebo had a recurrence in hyperkalemia compared with those on the drug during an additional 8 weeks of follow-up (60% versus 15%, P<0.001). Within 4 weeks, 76% of patients hit the target potassium level of 3.8 to 5.0 mmol/L, they reported, and 107 of those patients were then randomly assigned to either the drug or placebo for the randomized withdrawal phase. Matthew Weir, MD, of the University of Maryland, and colleagues evaluated 237 patients given the drug to treat high potassium levels. Those taking 5 and 10 g maintained those decreases in the long run compared with placebo, the researchers said.Īdverse event rates were similar between drug and placebo groups, and diarrhea was the most common complication.Īnother study in the New England Journal of Medicine looked at a second investigational agent for hyperkalemia: patiromer, a nonabsorbed polymer that binds potassium in exchange for calcium, predominantly in the distal colon where the concentration of free potassium is the highest. Patients who achieved normokalemia were then randomized to one of three doses of the drug (5, 10, or 15 g) or to placebo for 28 days. In the HARMONIZE trial, 258 patients were assigned to 10 g of the drug three times daily in the initial 48-hour, open-label phase. The drug comes as a fine powder that dissolves in water and is tasteless. ZS-9 is an inorganic cation exchanger with a high selectivity for potassium, and drugmaker ZS Pharma says its product can bind nine times as much potassium as Kayexalate, an organic polymer resin. Nephrologists have acknowledged a need for additional therapies for hyperkalemia. Hyperkalemia is typically treated with sodium polystyrene sulfonate (Kayexalate), but questions have arisen about its potential intestinal toxicity. ![]() According to an editorial in the New England Journal of Medicine, the long-term side effect profile of the drugs is unclear, but "both agents appear to offer some promise for the treatment of hyperkalemia in patients with chronic kidney and cardiac disease."Įlevated potassium levels are common in CKD and heart failure, and are often exacerbated by the mainstay of therapy, renin-angiotensin-aldosterone system (RAAS) inhibition. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |