Skip to main content
SpringerLink
Log in

Renal formulas pretreated with medications alters the nutrient profile

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (2014) U.S. Renal Data System. USRDS 2014 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda

  2. Wong H, Mylrea K, Feber J, Drukker A, Filler G (2006) Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 70:585–590

    CAS  PubMed  Google Scholar 

  3. Rivard AL, Raup SM, Beilman GJ (2004) Sodium polystyrene sulfonate used to reduce the potassium content of a high-protein enteral formula: a quantitative analysis. J Parenter Enteral Nutr 28:76–78

    Article  CAS  Google Scholar 

  4. Bunchman TE, Wood EG, Schenck MH, Weaver KA, Klein BL, Lynch RE (1991) Pretreatment of formula with sodium polystyrene sulfonate to reduce dietary potassium intake. Pediatr Nephrol 5:29–32

    Article  CAS  PubMed  Google Scholar 

  5. Starbuck WC (1972) Reduction of potassium and calcium in milk by sodium sulfonated polystyrene resins. Kidney Int 2:175–177

    Article  CAS  PubMed  Google Scholar 

  6. Raaijmakers R, Houkes LM, Schröder CH, Willems JL, Monnens LA (2013) Pre-treatment of dairy and breast milk with sevelamer hydrochloride and sevelamer carbonate to reduce phosphate. Perit Dial Int 33:565–572

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Warady BA, Neu AM, Schaefer F (2014) Optimal care of the infant, child, and adolescent on dialysis: 2014 update. Am J Kidney Dis 64:128–142

    Article  PubMed  Google Scholar 

  8. Thompson K, Flynn J, Okamura D, Zhou L (2013) Pretreatment of formula or expressed breast milk with sodium polystyrene sulfonate (kayexalate) as a treatment for hyperkalemia in infants with acute or chronic renal insufficiency. J Ren Nutr 23:333–339

    Article  CAS  PubMed  Google Scholar 

  9. Cameron JC, Kennedy D, Feber J, Wong E, Geier P, Vaillancourt R (2013) Pretreatment of infant formula with sodium polystyrene sulfonate : focus on optimal amount and contact time. Paediatr Drugs 15:43–48

    Article  PubMed  Google Scholar 

  10. Fassinger N, Dabbagh S, Mukhopadhyay S, Lee DY (1998) Mineral content of infant formula after treatment with sodium polystyrene sulfonate or calcium polystyrene sulfonate. Adv Perit Dial 14:274–277

    CAS  PubMed  Google Scholar 

  11. Bonnet L, Goudable J, Accominotti M, Fontaine D, Cochat P (1997) Effect of ion exchange resins on the composition of milk. Nephrologie 18:287–289

    CAS  PubMed  Google Scholar 

  12. Ferrara E, Lemire J, Reznik VM, Grimm PC (2004) Dietary phosphorus reduction by pretreatment of human breast milk with sevelamer. Pediatr Nephrol 19:775–779

    Article  PubMed  Google Scholar 

  13. Wesseling-Perry K (2013) Bone disease in pediatric chronic kidney disease. Pediatr Nephrol 28:569–576

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bartosh SM, Leverson G, Robillard D, Sollinger HW (2003) Long-term outcomes in pediatric renal transplant recipients who survive into adulthood. Transplantation 76:1195–1200

    Article  PubMed  Google Scholar 

  15. Reina de la Torre ML, Navarro-Alarcon M, del Moral LM, Lopez GSH, Palomares-Bayo M, Oliveras Lopez MJ, Blanca Herrera RM, Agil A (2014) Serum Zn levels and Cu/Zn ratios worsen in hemodialysis patients, implying increased cardiovascular risk: a 2-year longitudinal study. Biol Trace Elem Res 158:129–135

    Article  CAS  PubMed  Google Scholar 

  16. Roozbeh J, Sharifian M, Sagheb MM, Shabani S, Hamidian Jahromi A, Afshariani R, Pakfetrat M, Salehi O (2011) Comment on: does zinc supplementation affect inflammatory markers in hemodialysis patients? Ren Fail 33:466–467

    Article  PubMed  Google Scholar 

  17. Filler G, Felder S (2014) Trace elements in dialysis. Pediatr Nephrol 29:1329–1335

    Article  PubMed  Google Scholar 

  18. Bock DE, Prabhakaran V, Filler G (2009) Picture of the month: severe zinc deficiency in infancy (acrodermatitis enteropathica-like picture). Arch Pediatr Adolesc Med 163:765–766

    Article  PubMed  Google Scholar 

  19. American Academy of Pediatrics. Committee on Nutrition, Kleinman RE (2004) Pediatric nutrition handbook. American Academy of Pediatrics, Elk Grove Village

    Google Scholar 

  20. Burrell SA, Exley C (2010) There is (still) too much aluminium in infant formulas. BMC Pediatr 10:63

    Article  PubMed Central  PubMed  Google Scholar 

  21. Priest ND (2004) The biological behaviour and bioavailability of aluminium in man, with special reference to studies employing aluminium-26 as a tracer: review and study update. J Environ Monit 6:375–403

    Article  CAS  PubMed  Google Scholar 

  22. Bishop NJ, Morley R, Day JP, Lucas A (1997) Aluminum neurotoxicity in preterm infants receiving intravenous-feeding solutions. N Engl J Med 336:1557–1561

    Article  CAS  PubMed  Google Scholar 

  23. Cannata-Andia JB (2001) Reconsidering the importance of long-term low-level aluminum exposure in renal failure patients. Semin Dial 14:5–7

    Article  CAS  PubMed  Google Scholar 

  24. Hutchison AJ, Smith CP, Brenchley PE (2011) Pharmacology, efficacy and safety of oral phosphate binders. Nat Rev Nephrol 7:578–589

    Article  CAS  PubMed  Google Scholar 

  25. Van Goidsenhoven GM, Gray OV, Price AV, Sanderson PH (1954) The effect of prolonged administration of large doses of sodium bicarbonate in man. Clin Sci (Lond) 13:383–401

    Google Scholar 

Download references

Acknowledgments

We thank our pharmacists, Chelsey Jensen and Valerie Smith, who provided assistance with the technical, dosage, and administration aspects of the pharmaceutical agents used in this study; Douglas Bittel and Patricia Cudmore for their assistance and training in the lab; Robin Carroll and the Patient Care Services Research staff for assisting in the approval and logistics of this study; Children’s Mercy Hospital and the University of Kansas Medical Center for their support and use of resources and space that was needed to complete this study.

Funding

This work was supported by the Children’s Mercy Hospital Patient Care Services Research Fund and Department of Nutrition Services funding, KL2 TR000119-04.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Nutrition Services, Children’s Mercy Hospital & Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Jacob M. Taylor & Leah Oladitan

  2. KU Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4013, Kansas City, KS, 66160, USA

    Jacob M. Taylor, Susan Carlson & Jill M. Hamilton-Reeves

Authors
  1. Jacob M. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leah Oladitan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jill M. Hamilton-Reeves
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacob M. Taylor.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taylor, J.M., Oladitan, L., Carlson, S. et al. Renal formulas pretreated with medications alters the nutrient profile. Pediatr Nephrol 30, 1815–1823 (2015). https://doi.org/10.1007/s00467-015-3115-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-015-3115-5

Keywords

Search

Navigation