Pretreatment of enteral nutrition with sodium polystyrene sulfonate: effective, but beware the high prevalence of electrolyte derangements in clinical practice

被引:13
作者
Le Palma, Krisha [1 ]
Pavlick, Elisha Rampolla [2 ]
Copelovitch, Lawrence [3 ]
机构
[1] Childrens Hosp Philadelphia, Dept Pharm, Philadelphia, PA 19104 USA
[2] Childrens Hosp Philadelphia, Dept Clin Nutr, Philadelphia, PA 19104 USA
[3] Childrens Hosp Philadelphia, Div Nephrol, Philadelphia, PA 19104 USA
关键词
chronic renal failure; CKD; hyperkalemia; nutrition; pediatrics; GLOMERULAR-FILTRATION-RATE; POTASSIUM CONTENT; INFANT FORMULA; REDUCE;
D O I
10.1093/ckj/sfx138
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Current treatment options for chronic hyperkalemia in children with chronic kidney disease include dietary restrictions or enteral sodium polystyrene sulfonate (SPS); however, dietary restrictions may compromise adequate nutrition and enteral SPS may be limited by palatability, adverse effects and feeding tube obstruction. A potentially safer alternative is to pretreat enteral nutrition (EN) with SPS prior to consumption. The purpose of this study was to evaluate the efficacy and safety of pretreating EN with SPS in pediatric patients with hyperkalemia. Methods: We performed a retrospective cohort study between September 2012 and May 2016 at the Children's Hospital of Philadelphia. In all, 14 patients (age range 0.5-53.2 months) who received 19 courses of SPS pretreatment of EN were evaluated. Serum electrolytes were evaluated at baseline and within 1 week of initiating therapy. The primary endpoint was mean change in potassium at 7 days. Secondary endpoints included the mean change in serum sodium, chloride, bicarbonate, calcium, phosphorous and magnesium, as well as the percentage of patients who developed electrolyte abnormalities within the first week of treatment. Results: Serum potassium levels decreased from 6.0 to 4.4 mmol/L (P < 0.001) and serum sodium levels increased from 135.8 to 141.3 mmol/L (P = 0.008) 1 week after initiating SPS pretreatment. No significant differences in mean serum calcium or magnesium levels were noted. Nevertheless, more than half of the courses resulted in at least one electrolyte abnormality, with hypokalemia (31.6%), hypernatremia (26.3%) and hypocalcemia (21.1%) occurring most frequently. Conclusions: Pretreatment of EN with SPS is an effective method for treating chronic hyperkalemia in pediatric patients; however, close monitoring of electrolytes is warranted.
引用
收藏
页码:166 / 171
页数:6
相关论文
共 12 条
[1]   A SIMPLE ESTIMATE OF GLOMERULAR-FILTRATION RATE IN LOW-BIRTH-WEIGHT INFANTS DURING THE 1ST YEAR OF LIFE - NONINVASIVE ASSESSMENT OF BODY-COMPOSITION AND GROWTH [J].
BRION, LP ;
FLEISCHMAN, AR ;
MCCARTON, C ;
SCHWARTZ, GJ .
JOURNAL OF PEDIATRICS, 1986, 109 (04) :698-707
[2]   PRETREATMENT OF FORMULA WITH SODIUM POLYSTYRENE SULFONATE TO REDUCE DIETARY POTASSIUM INTAKE [J].
BUNCHMAN, TE ;
WOOD, EG ;
SCHENCK, MH ;
WEAVER, KA ;
KLEIN, BL ;
LYNCH, RE .
PEDIATRIC NEPHROLOGY, 1991, 5 (01) :29-32
[3]   Nutritional Delivery in Infants With CKD: Techniques to Avoid Hyperkalemia [J].
Bunchman, Timothy E. .
JOURNAL OF RENAL NUTRITION, 2013, 23 (05) :387-388
[4]   Pretreatment of Infant Formula with Sodium Polystyrene Sulfonate Focus on Optimal Amount and Contact Time [J].
Cameron, Jean-Christy F. ;
Kennedy, Dana ;
Feber, Janusz ;
Wong, Elaine ;
Geier, Pavel ;
Vaillancourt, Regis .
PEDIATRIC DRUGS, 2013, 15 (01) :43-48
[5]  
Fassinger N, 1998, ADV PERIT D, V14, P274
[6]  
Marti Bonmati E, 2008, Farm Hosp, V32, P91
[7]   Effects of water soaking and/or sodium polystyrene sulfonate addition on potassium content of foods [J].
Picq, Christian ;
Asplanato, Marion ;
Bernillon, Noemie ;
Fabre, Claudie ;
Roubeix, Mathilde ;
Ricort, Jean-Marc .
INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION, 2014, 65 (06) :673-677
[8]   Sodium polystyrene sulfonate used to reduce the potassium content of a high-protein enteral formula: A quantitative analysis [J].
Rivard, AL ;
Raup, SM ;
Beilman, GJ .
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, 2004, 28 (02) :76-78
[9]   New Equations to Estimate GFR in Children with CKD [J].
Schwartz, George J. ;
Munoz, Alvaro ;
Schneider, Michael F. ;
Mak, Robert H. ;
Kaskel, Frederick ;
Warady, Bradley A. ;
Furth, Susan L. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2009, 20 (03) :629-637
[10]  
SCHWARTZ GJ, 1987, PEDIATR CLIN N AM, V34, P571