Kayexalate and Patiromer effective in lowering serum potassium concentration: Study
Both Kayexalate and Patiromer were effective in lowering the serum potassium concentration, according to a new research published in the American Society of Nephrology
While Kayexalate increased the sodium content of the formula by almost 100 to 300%, and reduced the calcium concentration by 40%, Patiromer did not affect the sodium concentration and increased the calcium concentration by 40%.
Hyperkalemia is one of the common metabolic abnormalities seen in patients with renal failure. Management includes combination of low-potassium diet with additional potassium-binding medications if necessary.
However, these measures are impractical in infants whose dietary intake is predominantly milk based and both breast as well as the renal milk formula, Similac PM 60:40, have high potassium content. Low-potassium milk formulas such as Renastart® and Renalcal® are not readily available.
Pretreatement of milk with Kayexalate has been utilized as an effective means of reducing the milk potassium content. As Kayexalate exchanges sodium for potassium, it results in extra sodium load that is undesirable in patients with hypertension; moreover, Kayexalate also binds calcium thus decreasing calcium intake. Patiromer (Veltassa®), a recently introduced sodium-free potassium-binder exchanges calcium for potassium thus avoiding both hypernatremia and hypocalcemia.
Hence, Chadha, Vimal and colleagues from the Children's Mercy, Kansas City, Missouri, United States carried out the present study to assess the potassium binding effectiveness of Patiromer and compared it with Kayexalate by pretreating Similac® PM 60:40 milk formula.
Three different concentrations of Kayexalate (3.4, 6.8, and 13.6 g/L) and Patiromer (8.4, 16.8, and 33.6 g/L) were used. Supernatant samples were collected at 30, 60, and 120 minutes respectively. Samples were analyzed for sodium, potassium, calcium, and magnesium. The experiment was conducted in duplicate.
The authors concluded that " both Kayexalate and Patiromer were effective in lowering the potassium concentration. While Kayexalate increased the sodium content of the formula by almost 100 to 300%, and reduced the calcium concentration by 40%, Patiromer did not affect the sodium concentration and increased the calcium concentration by 40%. Both Kayexalate and Patiromer decreased the magnesium concentration with the decrease being more pronounced with Kayexalate."
Knowledge of these electrolyte changes is crucially important in the care of infants with renal disease as they are vulnerable to negative consequences of electrolyte imbalance, they further added.
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