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. 2022 Jul 25;20(1):333.
doi: 10.1186/s12967-022-03530-4.

Effects of different potassium-lowering regimens on acute hyperkalemia in hemodialysis patients: a real-world, retrospective study

Lan Yao  1   2 , Xiaoyang Xing  1   3 , Yubao Li  1 , Fangxing Zhang  1 , Ping Li  1 , Xianhui Liang  1 , Pei Wang  4   5
Affiliations

Effects of different potassium-lowering regimens on acute hyperkalemia in hemodialysis patients: a real-world, retrospective study

Lan Yao et al. J Transl Med. .

Abstract

Background: Hyperkalemia is a common and potentially life-threatening electrolyte disorder in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the efficacy and safety of potassium-lowering regimens during treatment of acute hyperkalemia in MHD patients.

Methods: This retrospective real-world study (RWS) was conducted among 139 MHD patients. They were given different potassium-lowering regimens, viz. the insulin and glucose (IG) intravenous administration group (IG, 46 patients), the sodium polystyrene sulfonate group (SPS, 33 patients), the sodium zirconium cyclosilicate group (SZC, 38 patients), the IG + SZC group (22 patients). The primary efficacy end point was the rate of serum potassium decline at 2 h. The rates of adverse events were also compared.

Results: At 2 h, the mean ± SE change of serum potassium level was - 0.71 ± 0.32 mmol per liter (mmol/L) in IG group, - 0.43 ± 0.38 mmol/L in SPS group, - 0.64 ± 0.36 mmol/L in SZC group, - 1.43 ± 0.38 mmol/L in IG + SZC group (P < 0.01). The serum potassium level in IG + SZC group decreased more than that in the other three groups (P < 0.01), while the serum potassium level in SPS group decreased less than that in the other three groups (P < 0.05). There was no significant difference on the decrease of the serum potassium level between IG group and the SZC group (P = 0.374). The IG group and the IG + SZC group had higher rates of symptomatic hypoglycemia. The SPS group had significant decreases of serum calcium and serum magnesium after treatment.

Conclusions: Among MHD patients with acute hyperkalemia, SZC had similar potassium-lowering efficacy with IG intravenous administration at 2 h and superior on convenience and side-effects.

Keywords: Chronic kidney disease; Hemodialysis; Hyperkalemia; Potassium-lowering regimens; Sodium zirconium cyclosilicate.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Effects of different potassium-lowering regimens on acute hyperkalemia in hemodialysis patients
Fig. 2
Fig. 2
Patient flow diagram of study cohort and excluded patients
Fig. 3
Fig. 3
The distribution of serum potassium levels in each group, ** is the comparison of IG + SZC compared with the other three groups, P < 0.01
Fig. 4
Fig. 4
Sankey diagram of changes in serum potassium levels after treatment in each group
Fig. 5
Fig. 5
Comparison of serum potassium levels before and after treatment in each group, **P < 0.01
Fig. 6
Fig. 6
Comparison of serum potassium decrease in each group, ** means P < 0.01 for IG + SZC compared with the other 3 groups in the pairwise comparison, *P < 0.05 for SPS compared with the other 3 groups in the pairwise comparison
Fig. 7
Fig. 7
The rate of serum potassium compliance, the control rate of severe hyperkalemia and the rate of serum potassium reduction < 0.2 mmol/L in each group, *P < 0.05
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