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Gastrointestinal Adverse Events with Sodium Polystyrene Sulfonate (Kayexalate) Use: A Systematic Review

  • Ziv Harel
    Correspondence
    Requests for reprints should be addressed to Ziv Harel, MD, MSc, 61 Queen St, Room 730, Toronto ON M5B 1W8
    Affiliations
    Division of Nephrology, St Michael's Hospital, University of Toronto, Ontario, Canada

    Department of Medicine and Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Ontario, Canada
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  • Shai Harel
    Affiliations
    Division of Nephrology, St Michael's Hospital, University of Toronto, Ontario, Canada
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  • Prakesh S. Shah
    Affiliations
    Department of Pediatrics, University of Toronto, Ontario, Canada

    Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

    Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
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  • Ron Wald
    Affiliations
    Division of Nephrology, St Michael's Hospital, University of Toronto, Ontario, Canada

    Department of Medicine and Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Ontario, Canada
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  • Jeffrey Perl
    Affiliations
    Division of Nephrology, St Michael's Hospital, University of Toronto, Ontario, Canada

    Department of Medicine and Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Ontario, Canada
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  • Chaim M. Bell
    Affiliations
    Department of Medicine and Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Ontario, Canada

    Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

    Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
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Published:January 14, 2013DOI:https://doi.org/10.1016/j.amjmed.2012.08.016

      Abstract

      Background

      Sodium polystyrene sulfonate (Kayexalate; Sanofi-Aventis, Paris, France) is a cation-exchange resin routinely used in the management of hyperkalemia. However, its use has been associated with colonic necrosis and other fatal gastrointestinal adverse events. Although the addition of sorbitol to sodium polystyrene sulfonate preparations was previously believed to be the cause of gastrointestinal injury, recent reports have suggested that sodium polystyrene sulfonate itself may be toxic. Our objective was to systematically review case reports of adverse gastrointestinal events associated with sodium polystyrene sulfonate use.

      Methods

      MEDLINE (1948 to July 2011), EMBASE (1980 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (1993 to July 27, 2011), bibliographies of identified articles, and websites of relevant drug agencies and professional associations in the United States and Canada were reviewed to identify eligible reports of adverse gastrointestinal events associated with sodium polystyrene sulfonate use. Causality criteria of the World Health Organization causality assessment system were applied to each report.

      Results

      Thirty reports describing 58 cases (41 preparations containing sorbitol and 17 preparations without sorbitol) of adverse events were identified. The colon was the most common site of injury (n=44; 76%), and transmural necrosis (n=36; 62%) was the most common histopathologic lesion reported. Mortality was reported in 33% of these cases due to gastrointestinal injury.

      Conclusions

      Sodium polystyrene sulfonate use, both with and without sorbitol, may be associated with fatal gastrointestinal injury. Physicians must be cognizant of the risk of these adverse events when prescribing this therapy for the management of hyperkalemia.

      Keywords

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