Prescription patterns of sodium and calcium polystyrene sulfonate in patients with hyperkalemia and chronic kidney disease receiving RAAS inhibitors.
Prescription patterns of sodium and calcium polystyrene sulfonate in patients with hyperkalemia and chronic kidney disease receiving RAAS inhibitors.
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DOI：
10.1093/ckj/sfac077
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发表时间：
2022-09
影响因子：
4.6
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中科院分区：
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聚苯乙烯磺酸钠和聚苯乙烯磺酸钙（SPS/CPS）阳离子交换树脂长期以来在临床上用于治疗慢性肾病（CKD）患者的高钾血症。然而，关于SPS/CPS用于高钾血症急性和慢性管理的实际使用存在不确定性。我们评估了SPS/CPS的处方模式及其对G3-G5期CKD患者在新发高钾血症发作后接受肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗的影响。我们使用加拿大马尼托巴的人群水平管理数据库进行了一项回顾性队列研究，其中包括2007年1月至2017年12月期间新发高钾血症（≥5.5 mmol/L）且接受RAASi处方的CKD成人患者。共有10009人被纳入我们的研究队列。在研究人群中，4%的人在高钾血症发作后30天内接受了SPS/CPS处方。其中，22%的人接受了1天的SPS/CPS供应，7%的人接受了超过30天的处方。基线时使用RAASi的8145例患者在首次高钾血症发作后存活90天。其中，1447人（18%）停用RAAS抑制剂，339人（5%）接受SPS/CPS处方。此外，在接受和未接受SPS/CPS处方的患者中，停止RAASi的患者比例相似。在接受RAASi治疗的CKD患者中，高钾血症发作后SPS/CPS处方的频率较低。RAASi停药或剂量下调是治疗高钾血症最常用的药理学方法，这种策略剥夺了患者RAASi的心脏和肾脏保护获益。需要在这一人群中管理高钾血症的新选择。
Sodium and calcium polystyrene sulfonate (SPS/CPS) cation-exchange resins have had long-standing clinical use for hyperkalemia in patients with chronic kidney disease (CKD). However, uncertainty exists regarding the real-world usage of SPS/CPS for acute and chronic management of hyperkalemia. We evaluated the prescription patterns of SPS/CPS and their impact on renin–angiotensin–aldosterone system inhibitor (RAASi) treatment in patients with CKD Stages G3–G5 after an episode of de novo hyperkalemia. We conducted a retrospective cohort study using population-level administrative databases in Manitoba, Canada, which included adults with CKD and a RAASi prescription who had an episode of de novo hyperkalemia (≥5.5 mmol/L) between January 2007 and December 2017. A total of 10 009 individuals were included in our study cohort. Among the study population, 4% received an SPS/CPS prescription within 30 days of their hyperkalemia episode. Of those, 22% received a 1-day supply of SPS/CPS and 7% received a prescription for more than 30 days. There were 8145 patients using RAASi at baseline who survived 90 days after their first hyperkalemia episode. Of those, 1447 (18%) discontinued their RAAS inhibitor and 339 (5%) received a prescription of SPS/CPS. Also, the proportion of patients who discontinued their RAASi was similar among those who did and did not receive a prescription of SPS/CPS. In patients with CKD receiving RAASi therapy, there is a low frequency of SPS/CPS prescription after an episode of hyperkalemia. RAASi discontinuation or downtitration is the most used pharmacologic approach for the management of hyperkalemia, a strategy that deprives patients of the cardiac and renal protective benefits of RAASi. New options for the management of hyperkalemia in this population are needed.
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