Ion-Exchange Resins for the Treatment of Hyperkalemia: Are They Safe and Effective?
Ion-Exchange Resins for the Treatment of Hyperkalemia: Are They Safe and Effective?
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DOI：
10.1681/asn.2010010079
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发表时间：
2010-05-01
影响因子：
13.6
通讯作者：
Chennupati, Sreedevi
中科院分区：
文献类型：
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作者：
Sterns, Richard H.;Rojas, Maria;Chennupati, Sreedevi
聚苯乙烯磺酸钠 (SPS) 是一种旨在与结肠中的钾结合的离子交换树脂，于 1958 年被美国食品和药物管理局批准用于治疗高钾血症，比要求药品制造商证明其药物的有效性和安全性早了 4 年。 2009 年 9 月，美国食品药品监督管理局 (FDA) 援引结肠坏死的报告发出警告，建议不要同时服用山梨醇，山梨醇是一种渗透性泻药，用于防止 SPS 引起的粪便嵌塞，并加快树脂向结肠的输送；然而，SPS 山梨醇预混悬液是许多医院药房唯一备有的制剂，通常用于治疗高钾血症。我们找不到令人信服的证据表明 SPS 会增加实验动物或人类粪便钾的损失，也没有证据表明在树脂中添加山梨醇会增加其治疗高钾血症的有效性。然而，人们越来越担心山梨醇中的 SPS 悬浮液可能有害。在转向这些基本上未经证实且可能有害的疗法之前，明智的做法是先用尽其他治疗高钾血症的替代方法。
Sodium polystyrene sulfonate (SPS), an ion-exchange resin designed to bind potassium in the colon, was approved in 1958 as a treatment for hyperkalemia by the US Food and Drug Administration, 4 years before drug manufacturers were required to prove the effectiveness and safety of their drugs. In September 2009, citing reports of colonic necrosis, the Food and Drug Administration issued a warning advising against concomitant administration of sorbitol, an osmotic cathartic used to prevent SPS-induced fecal impaction and to speed delivery of resin to the colon, with the powdered resin; however, a premixed suspension of SPS in sorbitol, the only preparation stocked by many hospital pharmacies, is prescribed routinely for treatment of hyperkalemia. We can find no convincing evidence that SPS increases fecal potassium losses in experimental animals or humans and no evidence that adding sorbitol to the resin increases its effectiveness as a treatment for hyperkalemia. There is growing concern, however, that suspensions of SPS in sorbitol can be harmful. It would be wise to exhaust other alternatives for managing hyperkalemia before turning to these largely unproven and potentially harmful therapies.