Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia
Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia
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聚苯乙烯磺酸钙和聚苯乙烯磺酸钠对透析前高钾血症患者矿物质和骨代谢以及容量超负荷的影响比较
DOI：
10.1007/s10157-017-1412-y
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发表时间：
2017
影响因子：
2.3
通讯作者：
Kei Fukam
中科院分区：
文献类型：
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作者：
Yosuke Nakayama;Kaoru Ueda;Sho-ichi Yamagishi;Miki Sugiyama;Chika Yoshida;Yuka Kurokawa;Nao Nakamura;Tomofumi Moriyama;Goh Kodama;Tomohisa Minezaki;Sakuya Ito;Akiko Nagata;Kensei Taguchi;Junko Yano;Yusuke Kaida;Kazutaka Shibatomi;Kei Fukam
背景：高钾血症在终末期肾病患者中很普遍，常与危及生命的心律失常有关。虽然聚苯乙烯磺酸盐（PS）通常用于治疗高钾血症，但目前还没有研究直接比较钙和钠PS （CPS和SPS）对矿物质和骨代谢的影响。方法采用随机交叉设计，对20例透析前高钾血症（> 5 mmol/l）患者分别给予口服CPS或SPS治疗4周。结果治疗4周后，两组患者血清钾(K)含量与基线比较（ΔK）差异无统计学意义。然而，SPS 9显著降低了血清钙（Ca）和镁（Mg），增加了完整的甲状旁腺激素（iPTH）值，而CPS降低了iPTH值。ΔiPTH与ΔCa、ΔMg呈负相关（r=-0.53、r=-0.50）。此外，SPS患者13的钠- 12 （Na）和房利钠肽（ANP）水平显著升高，而CPS患者13的钠- 12和房利钠肽（ANP）水平无显著升高，而ΔNa和ΔANP在所有患者中均与14显著相关。我们还发现ΔNa和Δ （Na to chloride ratio）与ΔHCO3-呈正相关。在人工结肠液中，CPS增加Ca， 16降低Na。此外，SPS更能降低K、Mg和NH3。结论：与SPS相比，CPS可能更安全用于治疗透析前患者的高钾血症18，因为它不会引起甲状旁腺功能亢进或容量过载。19
Background Hyperkalemia is prevalent in end-stage renal disease patients, being 2 involved in life-threatening arrhythmias. Although polystyrene sulfonate (PS) is 3 commonly used for the treatment of hyperkalemia, direct comparison of effects between 4 calcium and sodium PS (CPS and SPS) on mineral and bone metabolism has not yet 5 been studied. Methods In a randomized and crossover design, 20 pre-dialysis patients 6 with hyperkalemia (> 5 mmol/l) received either oral CPS or SPS therapy for 4 weeks. 7 Results After 4 week-treatments, there was no significant difference of changes in 8 serum potassium (K) from the baseline (ΔK) between the two groups. However, SPS 9 significantly decreased serum calcium (Ca) and magnesium (Mg) and increased intact 10 parathyroid hormone (iPTH) values, whereas CPS reduced iPTH. ΔiPTH was inversely 11 correlated with ΔCa and ΔMg (r=-0.53 and r=-0.50, respectively). Furthermore, sodium 12 (Na) and atrial natriuretic peptide (ANP) levels were significantly elevated in patients 13 with SPS, but not with CPS, whereas ΔNa and ΔANP were significantly correlated with 14 each other in all the patients. We also found that ΔNa and Δ (Na to chloride ratio) were 15 positively correlated with ΔHCO3-. In artificial colon fluid, CPS increased Ca and 16 decreased Na. Furthermore, SPS more decreased K, Mg, and NH3. Conclusion 17 Compared with SPS, CPS may be safer for the treatment of hyperkalemia in pre-dialysis 18 patients, because it did not induce hyperparathyroidism or volume overload. 19