Sodium polystyrene sulfonate use in hemodialysis patients tied to death from GI harm: Study

New Delhi: The use of sodium polystyrene sulfonate (SPS) in patients on hemodialysis may increase the chance of dying from gastrointestinal harm. The findings of the study were presented at the American Society of Nephrology's Kidney Week 2021. 

There are increasing concerns regarding the gastrointestinal (GI) safety of sodium polystyrene sulfonate (SPS), a medication commonly used in the management of hyperkalemia. The objective is to compare the risk for fatal, non-fatal and their composite GI events following initiation of SPS in patients on hemodialysis compared to non-use.

In the study, potassium binder SPS was given to 7107 (11.2%) of the 63,323 patients on hemodialysis (HD) in the 2002-2018 Dialysis Outcomes and Practice Patterns Study (DOPPS). In 895 patients (1.41%), physician-determined fatal gastrointestinal events occurred, including 150 (2.11%) who were administered SPS and 1.33% who did not take the medicine. Mesenteric infarction/ischemic bowel, intestine perforation, and peptic ulcer perforation were all fatal occurrences.

Farfan Ruiz AC and team reported that after propensity score matching, scientists discovered a substantial 30% elevated risk for fatal gastrointestinal events among SPS users versus nonusers. The researchers also looked at facility-level data. In comparison to dialysis facilities with no SPS usage, facilities with 1-10%, 11-20%, 21-30%, and more than 30% SPS use had 24 percent, 82%, 11%, and 46% higher risks for fatal gastrointestinal events, respectively. Except for facility-level SPS utilization of 21-30%, all results were statistically significant.

According to the data, about one in every 128 dialysis patients who got SPS had a fatal gastrointestinal incident. Younger and male patients showed 2.4- and 1.7-fold higher risks, respectively. Both the presence of peripheral vascular disease and the lack of coronary artery disease was linked to a 1.5-fold higher risk. A dialysis vintage of more than 4 years and no diuretic usage were both linked with a 1.4-fold and 1.7-fold higher risk of fatal gastrointestinal events, respectively. The increased risk was also associated with the country of origin and a more recent era. The DOPPS cohort had a mean age of 65.4 years, with 61.6 percent being male. DOPPS countries included Australia/New Zealand, Belgium, France, Italy, Japan, Spain, Sweden, and others.

"Our results add to the growing concerns of SPS use as a therapeutic agent for the management of hyperkalemia," Dr. Ruiz stated in conclusion.

Reference:

Farfan Ruiz AC, Malick R, Rhodes E, et al. Fatal gastrointestinal events with sodium polystyrene sulfonate use in hemodialysis: an international cohort study. Presented at: Kidney Week 2021, November 2-7, 2021. Poster PO0849.