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. 2015 Oct;30(10):1815-23.
doi: 10.1007/s00467-015-3115-5. Epub 2015 May 1.

Renal formulas pretreated with medications alters the nutrient profile

Jacob M Taylor  1 , Leah Oladitan, Susan Carlson, Jill M Hamilton-Reeves
Affiliations

Renal formulas pretreated with medications alters the nutrient profile

Jacob M Taylor et al. Pediatr Nephrol. 2015 Oct.

Abstract

Background: Pretreating renal formulas with medications to lower the potassium and phosphorus content is common in clinical practice; however, the effect of this treatment on other nutrients is relatively unstudied. We examine whether nutrient composition is affected by pretreating renal formulas with sodium polystyrene sulfonate (SPS) suspension and sevelamer carbonate.

Methods: Fixed medication doses and treatment times were utilized to determine changes in the nutrient composition of Suplena® and Similac® PM 60/40. The effect of simultaneously adding both medications (co-administration) to the formula on the nutrient composition of Suplena® was also evaluated.

Results: Pretreatment of Suplena® with SPS reduced the concentrations of calcium (11-38 %), copper (3-11 %), manganese (3-16 %), phosphorus (0-7 %), potassium (6-34 %), and zinc (5-20 %) and increased those of iron (9-34 %), sodium (89-260 %), and sulfur (19-45 %) and the pH (0.20-0.50 units). Pretreatment of Similac® PM 60/40 with SPS reduced the concentrations of calcium (8-29 %), copper (5-19 %), magnesium (3-26 %), and potassium (33-63 %) and increased those of iron (13-87 %) and sodium (86-247 %) and the pH (0.40-0.81 units). Pretreatment of both formulas with the SPS suspension led to significant increases in the aluminum concentration in both formulas (507-3957 %). No differences in potassium concentration were observed between treatment times. Unexpectedly, the levels of neither phosphorus nor potassium were effectively reduced in Suplena® pretreated with sevelamer carbonate alone or when co-administered with SPS.

Conclusions: Pretreating formula with medications alters nutrients other than the intended target(s). Future studies should be aimed at predicting the loss of these nutrients or identifying alternative methods for managing serum potassium and phosphorus levels in formula-fed infants. The safety of pretreating formula with SPS suspension should also be examined.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Aluminum concentration of formula pretreated with sodium polystyrene sulfonate (SPS) suspension in the Low K Protocol. Individual values of aluminum for each dose level of SPS suspension in the Low K protocol are included. Due to differing levels of potassium in the formulas being tested, dose was converted to the amount (mL) of SPS suspension added to formula to standardize the measurement. Dose equivalent is 1 g SPS=4 mL of SPS suspension
See this image and copyright information in PMC

References

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