Adverse Gastrointestinal Events With Sodium Polystyrene Sulfonate Use in Patients on Maintenance Hemodialysis: An International Cohort Study.
Can J Kidney Health Dis 2023;
10:20543581231172405. [PMID:
37359984 PMCID:
PMC10288443 DOI:
10.1177/20543581231172405]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background
There are concerns regarding the gastrointestinal (GI) safety of sodium polystyrene sulfonate (SPS), a medication commonly used in the management of hyperkalemia.
Objective
To compare the risk of GI adverse events among users versus non-users of SPS in patients on maintenance hemodialysis.
Design
International prospective cohort study.
Setting
Seventeen countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] phase 2-6 from 2002 to 2018).
Patients
50 147 adults on maintenance hemodialysis.
Measurements
An adverse GI event defined by a GI hospitalization or GI fatality with SPS prescription compared with no SPS prescription.
Methods
Overlap propensity score-weighted Cox models.
Results
Sodium polystyrene sulfonate prescription was present in 13.4% of patients and ranged from 0.42% (Turkey) to 20.6% (Sweden) with 12.5% use in Canada. A total of 935 (1.9%) adverse GI events (140 [2.1%] with SPS, 795 [1.9%] with no SPS; absolute risk difference 0.2%) occurred. The weighted hazard ratio (HR) of a GI event was not elevated with SPS use compared with non-use (HR = 0.93, 95% confidence interval = 0.83-1.6). The results were consistent when examining fatal GI events and/or GI hospitalization separately.
Limitations
Sodium polystyrene sulfonate dose and duration were unknown.
Conclusions
Sodium polystyrene sulfonate use in patients on hemodialysis was not associated with a higher risk of an adverse GI event. Our findings suggest that SPS use is safe in an international cohort of maintenance hemodialysis patients.
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