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Gedefaw GD, Abuhay AG, Endeshaw YS, Birhan MA, Ayenew ME, Genet GB, Tilahun DW, Mekonnen HS, Legesse BT, Daka DT, Wondie WT, Abate AT. Incidence and predictors of acute kidney injury among asphyxiated neonates in comprehensive specialized hospitals, northwest Ethiopia, 2023. Sci Rep 2024; 14:16480. [PMID: 39013957 PMCID: PMC11252324 DOI: 10.1038/s41598-024-66242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/28/2024] [Indexed: 07/18/2024] Open
Abstract
Acute kidney injury (AKI) is characterized by a sudden decline in the kidneys' abilities to remove waste products and maintain water and electrolyte homeostasis. This study aims to determine the incidence and predictors of acute kidney injury among neonates with perinatal asphyxia admitted at the neonatal intensive care unit of West Amhara Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Multicentred institution-based retrospective follow-up study was conducted from October 1, 2021, to September 30, 2023, among 421 perinatal asphyxia neonates. A simple random sampling technique was used. The data were collected using a data extraction checklist from the medical registry of neonates. The collected data were entered into EPI-DATA V.4.6.0.0. and analyzed using STATA V.14. The Kaplan-Meier failure curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of Acute kidney injury. Statistical significance was declared at a p ≤ 0.05. The overall incidence of AKI was 54 (95% CI 47.07-62.51) per 100 neonate days. C/S delivery (AHR = 0.64; (95% CI 0.43-0.94), prolonged labor (AHR = 1.43; 95% CI 1.03-1.99) low-birth weight times (AHR = 1.49; (95% CI 1.01-2.20), stage three HIE(AHR: 1.68; (95% CI (1.02-2.77), No ANC follow up (AHR = 1.43; 95% CI 1.9 (1.07-3.43) and Hyperkalemia (AHR = 1.56; 95% CI 1.56 (1.05-2.29); 95% CI) were significant predictors. The incidence rate of acute kidney injury was higher than in other studies conducted on other groups of neonates. Cesarean section delivery, prolonged low birthweight, no Anc follow-up, stage 3 HIE, and neonatal hyperkalemia were predictors of acute kidney injury. However, it needs further prospective study. Therefore, the concerned stakeholders should give due attention and appropriate intervention to these predictors.
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Affiliation(s)
- Gezahagn Demsu Gedefaw
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia.
| | - Abere Gebru Abuhay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yaregal Semanew Endeshaw
- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Collage of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Marta Adugna Birhan
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Endalamaw Ayenew
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Geta Bayu Genet
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Degalem Worku Tilahun
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollaga University, Nekemte, Ethiopia
| | | | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences and referral hospital, Ambo University, Ambo, Ethiopia
| | - Asnake Tadesse Abate
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Shaw V, Anderson C, Desloovere A, Greenbaum LA, Haffner D, Nelms CL, Paglialonga F, Polderman N, Qizalbash L, Renken-Terhaerdt J, Stabouli S, Tuokkola J, Vande Walle J, Warady BA, Shroff R. Nutritional management of the infant with chronic kidney disease stages 2-5 and on dialysis. Pediatr Nephrol 2023; 38:87-103. [PMID: 35378603 PMCID: PMC9747855 DOI: 10.1007/s00467-022-05529-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023]
Abstract
The nutritional management of children with chronic kidney disease (CKD) is of prime importance in meeting the challenge of maintaining normal growth and development in this population. The objective of this review is to integrate the Pediatric Renal Nutrition Taskforce clinical practice recommendations for children with CKD stages 2-5 and on dialysis, as they relate to the infant from full term birth up to 1 year of age, for healthcare professionals, including dietitians, physicians, and nurses. It addresses nutritional assessment, energy and protein requirements, delivery of the nutritional prescription, and necessary dietary modifications in the case of abnormal serum levels of calcium, phosphate, and potassium. We focus on the particular nutritional needs of infants with CKD for whom dietary recommendations for energy and protein, based on body weight, are higher compared with children over 1 year of age in order to support both linear and brain growth, which are normally maximal in the first 6 months of life. Attention to nutrition during infancy is important given that growth is predominantly nutrition dependent in the infantile phase and the growth of infants is acutely impaired by disruption to their nutritional intake, particularly during the first 6 months. Inadequate nutritional intake can result in the failure to achieve full adult height potential and an increased risk for abnormal neurodevelopment. We strongly suggest that physicians work closely with pediatric renal dietitians to ensure that the infant with CKD receives the best possible nutritional management to optimize their growth and development.
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Affiliation(s)
- Vanessa Shaw
- University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Caroline Anderson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Dieter Haffner
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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3
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Iida T, Nishimura T, Mizukoshi Y, Tsuruoka T, Hisano M. A case of 1-month-old female infant delaying peritoneal dialysis introduction by low-potassium anti-allergic formula treated with sodium polystyrene sulfonate. CEN Case Rep 2022; 11:482-486. [PMID: 35441977 DOI: 10.1007/s13730-022-00704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022] Open
Abstract
The 8806H formula is the only renal formula available for pediatric patients with chronic kidney disease in Japan. A 1-month-old female infant could not be administered 8806H because of milk allergy. Administration of low-potassium anti-allergic formula treated with sodium polystyrene sulfonate maintained adequate serum potassium levels, and introduction of peritoneal dialysis could be delayed. The patient had severe renal dysfunction secondary to bilateral hypoplastic and multi-cystic kidneys. Although she received the 8806H formula, this product was switched to hydrolyzed casein formula because she developed allergy to 8806H at 28 days of age, which led to hyperkalemia. We initiated treatment with sodium polystyrene sulfonate at 40 days of age to lower the potassium concentration in milk, which prevented hyperkalemia and maintained the patient's nutritional status to ensure appropriate increase in body weight. We monitored electrolyte levels in milk and confirmed reduction in potassium levels before feeding. Although such condition is rare and there are few reports of potassium reduction in anti-allergic formulas, this strategy may be useful for pediatric patients with renal insufficiency who cannot be treated with renal formulas because of milk allergy.
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Affiliation(s)
- Takaya Iida
- Department of Nephrology, Chiba Children's Hospital, 579-1 heta-cho, midori-ku, Chiba-shi, Chiba, 266-0007, Japan.
| | - Tatsuya Nishimura
- Department of Nephrology, Chiba Children's Hospital, 579-1 heta-cho, midori-ku, Chiba-shi, Chiba, 266-0007, Japan
| | - Yoko Mizukoshi
- Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Tomoko Tsuruoka
- Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Masataka Hisano
- Department of Nephrology, Chiba Children's Hospital, 579-1 heta-cho, midori-ku, Chiba-shi, Chiba, 266-0007, Japan
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Desloovere A, Renken-Terhaerdt J, Tuokkola J, Shaw V, Greenbaum LA, Haffner D, Anderson C, Nelms CL, Oosterveld MJS, Paglialonga F, Polderman N, Qizalbash L, Warady BA, Shroff R, Vande Walle J. The dietary management of potassium in children with CKD stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2021; 36:1331-1346. [PMID: 33730284 PMCID: PMC8084813 DOI: 10.1007/s00467-021-04923-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/18/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
Dyskalemias are often seen in children with chronic kidney disease (CKD). While hyperkalemia is common, with an increasing prevalence as glomerular filtration rate declines, hypokalemia may also occur, particularly in children with renal tubular disorders and those on intensive dialysis regimens. Dietary assessment and adjustment of potassium intake is critically important in children with CKD as hyperkalemia can be life-threatening. Manipulation of dietary potassium can be challenging as it may affect the intake of other nutrients and reduce palatability. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) for the dietary management of potassium in children with CKD stages 2-5 and on dialysis (CKD2-5D). We describe the assessment of dietary potassium intake, requirements for potassium in healthy children, and the dietary management of hypo- and hyperkalemia in children with CKD2-5D. Common potassium containing foods are described and approaches to adjusting potassium intake that can be incorporated into everyday practice discussed. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.
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Affiliation(s)
| | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vanessa Shaw
- UCL Great Ormond Street Institute of Child Health, London, UK.
- University of Plymouth, Plymouth, UK.
| | - Larry A Greenbaum
- Emory University, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Dieter Haffner
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Caroline Anderson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Michiel J S Oosterveld
- Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | - Rukshana Shroff
- UCL Great Ormond Street Institute of Child Health, London, UK
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Vardhelli V, Murki S, Kallem VR. Case 2: A Salty Baby. Neoreviews 2020; 21:e691-e694. [PMID: 33004563 DOI: 10.1542/neo.21-10-e691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Robert S, Nisse YE, Henn-Ménétré S, Vrillon I, Demoré B. [Case report of an infant hyperkalemia: Suggestion of a hospital procedure for the milk pretreatment with sodium polystyrene sulfonate resin]. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 78:287-293. [PMID: 32439127 DOI: 10.1016/j.pharma.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Sodium polystyrene sulfonate (SPS) is used to reduce intestinal potassium absorption in hyperkalemia during conservative management of chronic renal failure in infants. Milk can be pretreated by SPS to reduce the risk of enteropathy associated with oral or rectal administration. We report the case of an infant for whom this pre-treatment has been implemented. The objective of this work was to define the hospital procedure for the pre-treatment of milk by the SPS. This pre-treatment involves both a drug and infant milk. Each product has its own regulation and their processes do not normally cross each other. The roles of each contributor were therefore defined: prescription of pre-treated milk (dose of SPS and volume of milk) by the physician, dispensing of SPS by the pharmacist, delivery of milk by the milk kitchen staff, pre-treatment by a nurse and administration by a nursing auxiliary. The preparation of the bottles is as follows: placing approximately 1g of SPS per 100mL of milk in contact, stirring, resting in the refrigerator for one hour, taking the supernatant to be administered. In the reported case, serum potassium levels were reduced from 5.57mmol/L before treatment to 4.53mmol/L after treatment, in line with the 20% decrease found in the literature. This method of administration is beneficial in terms of tolerance and acceptability. The preparation is simple and allows going back home under treatment.
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Affiliation(s)
- S Robert
- Pôle pharmacie stérilisation, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Y-E Nisse
- Pôle pharmacie stérilisation, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - S Henn-Ménétré
- Pôle pharmacie stérilisation, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - I Vrillon
- Médecine infantile, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - B Demoré
- Pôle pharmacie stérilisation, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France; APEMAC, université de Lorraine, 54000 Nancy, France
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7
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Shahar‐Nissan K, Peled O, Krause I. The ice cream challenge: A favourable extemporaneous Kayexalate formulation improves compliance in paediatric patients. Br J Clin Pharmacol 2019; 85:2450-2452. [PMID: 31392771 PMCID: PMC6783585 DOI: 10.1111/bcp.14067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Keren Shahar‐Nissan
- Department of Pediatrics CSchneider Children's Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Orit Peled
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of PharmacySchneider Children's Medical CenterPetah TikvaIsrael
| | - Irit Krause
- Department of Pediatrics CSchneider Children's Medical CenterPetah TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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8
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Treatment of infant formula with patiromer dose dependently decreases potassium concentration. Pediatr Nephrol 2019; 34:1395-1401. [PMID: 30963285 DOI: 10.1007/s00467-019-04232-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hyperkalemia is a potentially life-threatening complication of chronic kidney disease (CKD). Dietary potassium restriction is challenging in infants despite low-potassium formulas. Decreasing potassium in formula using patiromer, a new calcium-based cation exchange polymer may be one option to accomplish this; however, data confirming efficacy is lacking. METHODS Varying doses of patiromer were added to prepared Similac Advance and Similac PM 60/40. Measurements of potassium, calcium, sodium, magnesium, and phosphorus were obtained at baseline and at 30 min, 60 min, and 24 h following patiromer administration. RESULTS Following pre-treatment with patiromer, the potassium concentration of both formulas decreased. This effect was mild with the lowest dose but increased in a dose-dependent fashion. Treating for 60 min or 24 h did not yield substantially greater effects than treating for 30 min. Calcium levels increased in both formula groups, mostly in a dose-dependent fashion. Changes in magnesium, sodium, and phosphorus were also seen after patiromer pre-treatment. CONCLUSIONS Pre-treatment with patiromer decreases the potassium concentration of infant formula. Calcium levels increased after treatment as expected with the majority of ion exchange occurring in 30 min. Treatment of formula with patiromer shows promise as a unique option for managing hyperkalemia.
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Nelms CL. Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD). Front Pediatr 2018; 6:214. [PMID: 30116725 PMCID: PMC6083216 DOI: 10.3389/fped.2018.00214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/12/2018] [Indexed: 12/25/2022] Open
Abstract
Growth in pediatric Chronic Kidney Disease is important for long-term outcomes including final adult height and cognitive function. However, there are many barriers for children with chronic kidney disease to achieve adequate nutritional intake to optimize growth. This review highlights these unique concerns, including route of nutrition, dialysis contributions and biochemical indices. Fitting the enteral feeding to the patients' needs involves choosing an appropriate product or products, limiting harmful nutrients in excess, notably aluminum, and altering for electrolyte and micronutrient needs. Unique adjustments to the enteral regimen include accommodating volume needs, optimizing macronutrient ratios, specific electrolyte adjustments, the blending of products together, and adjustments made to consider patient and family psychosocial needs. When a holistic approach to medical nutrition therapy is applied, taking the above factors into consideration, adequate intake for growth of the child with CKD is achievable.
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Affiliation(s)
- Christina L. Nelms
- PedsFeeds, Kearney, NE, United States
- Department of Family Studies, University of Nebraska System, Kearney, NE, United States
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Stauss M, So B, Reynolds B. Let food be thy medicine and medicine be thy food? Clin Kidney J 2018; 11:162-165. [PMID: 29992017 PMCID: PMC6019050 DOI: 10.1093/ckj/sfy008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022] Open
Abstract
Ensuring adequate nutrition in children with chronic kidney disease whilst avoiding hyperkalaemia can be a difficult balance to achieve. Pre-treatment of feeds, whether milk, formula or enteral nutrition, with sodium polystyrene sulfonate (SPS) is practiced in some paediatric centres internationally. Such treatments are purported to avoid the potentially serious complications of direct administration of SPS, such as intestinal necrosis, aspiration pneumonitis and metabolic alkalosis to name but a few. Although described some 45 years ago, this study by Palma et al. is only the second retrospective study to describe the clinical consequence of pre-treating feeds with SPS with the majority of earlier studies describing only the in vitro effects of this method. Whilst effective in reducing serum potassium, the authors justifiably highlight the high incidence of complications, such as hypokalaemia (31.6%) and hypernatraemia (26.3%). We have further highlighted this with a summary of the available literature on this subject demonstrating the gross alterations of the electrolyte composition of feeds following SPS pre-treatment and clinical complications in its application. We heartily agree and support the conclusion by Palma et al. that where this therapy is practiced, close monitoring of electrolytes is essential and much more work is needed to identify those patient cohorts for which this can indeed be considered a safe and effective intervention.
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Affiliation(s)
- Madelena Stauss
- Department of Renal Medicine, Royal Preston Hospital, Preston, UK
| | - Beng So
- Department of Renal Medicine, Royal Preston Hospital, Preston, UK
| | - Ben Reynolds
- Renal Unit, Royal Hospital for Children, Glasgow, UK
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Le Palma K, Pavlick ER, Copelovitch L. Pretreatment of enteral nutrition with sodium polystyrene sulfonate: effective, but beware the high prevalence of electrolyte derangements in clinical practice. Clin Kidney J 2017; 11:166-171. [PMID: 29644055 PMCID: PMC5887418 DOI: 10.1093/ckj/sfx138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/03/2017] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Krisha Le Palma
- Department of Pharmacy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elisha Rampolla Pavlick
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lawrence Copelovitch
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy. Case Rep Nephrol 2017; 2017:6582613. [PMID: 28959498 PMCID: PMC5556615 DOI: 10.1155/2017/6582613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Sodium polystyrene sulfonate (SPS) is a chelating agent used for the treatment of hyperkalemia. SPS has a wide range of exchange capacity requiring close monitoring of serum electrolytes. We observed two patients who developed acute hypocalcemia and increased metabolic alkalosis after initiating SPS therapy. We report these cases to draw attention to the potential risk of this medication in pediatric patients. Case Diagnosis/Treatment Two children with chronic kidney disease on dialysis were started on SPS for hyperkalemia. Within a week after initiation of the medication, both patients developed hypocalcemia on routine labs without overt clinical manifestations. The hypocalcemia was rapidly corrected with oral supplementation and discontinuation of SPS. Conclusions Severe hypocalcemia can develop after SPS therapy. The metabolic alkalosis in these patients associated with the hypocalcemia put them at increased risk for complications. Hence, careful attention must be paid to the state of calcium metabolism in all patients receiving SPS. Often calcium supplementation is required to maintain normal calcium levels.
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13
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Renal formulas pretreated with medications alters the nutrient profile. Pediatr Nephrol 2015; 30:1815-23. [PMID: 25930981 PMCID: PMC4572699 DOI: 10.1007/s00467-015-3115-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 12/13/2022]
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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Khalil ST, Cabacungan E. Pseudohypoaldosteronism Type 1 (arPHA1) Treated With Sodium Polystyrene Sulfonate Pretreated Milk. Glob Pediatr Health 2015; 2:2333794X15569301. [PMID: 27335941 PMCID: PMC4784594 DOI: 10.1177/2333794x15569301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Syed Tariq Khalil
- Children’s Hospital of Wisconsin & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erwin Cabacungan
- Children’s Hospital of Wisconsin & Medical College of Wisconsin, Milwaukee, WI, USA
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15
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Bunchman TE. Nutritional delivery in infants with CKD: techniques to avoid hyperkalemia. J Ren Nutr 2013; 23:387-8. [PMID: 23706704 DOI: 10.1053/j.jrn.2013.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Timothy E Bunchman
- Department of Pediatric Nephrology, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond, Richmond, VA 23298, USA.
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