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Treatment of infant formula with patiromer dose dependently decreases potassium concentration

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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References

  1. Furth SL, Abraham AG, Jerry-Fluker J, Schwartz GJ, Benfield M, Kaskel F, Wong C, Mak RH, Moxey-Mims M, Warady BA (2011) Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease. Clin J Am Soc Nephrol 6:2132–2140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  3. Group KW (2009) KDOQI clinical practice guideline for nutrition in children with CKD: 2008 update. Executive summary. Am J Kidney Dis 53:S11–S104

    Google Scholar 

  4. Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D (2006) Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol 21:793–799

    Article  PubMed  Google Scholar 

  5. Scherr L, Ogden DA, Mead AW, Spritz N, Rubin AL (1961) Management of hyperkalemia with a cation-exchange resin. N Engl J Med 264:115–119

    Article  CAS  PubMed  Google Scholar 

  6. Ohlsson A, Hosking M (1987) Complications following oral administration of exchange resins in extremely low-birth-weight infants. Eur J Pediatr 146:571–574

    Article  CAS  PubMed  Google Scholar 

  7. Filippi L, Cecchi A, Dani C, Bertini G, Pezzati M, Rubaltelli FF (2004) Hypernatraemia induced by sodium polystyrene sulphonate (Kayexalate) in two extremely low birth weight newborns. Paediatr Anaesth 14:271–275

    Article  PubMed  Google Scholar 

  8. Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM (2013) Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med 126:264 e269–264 e224

    Article  CAS  Google Scholar 

  9. Wood EG, Bunchman TE, Khurana R, Fleming SS, Lynch RE (1990) Complications of nasogastric and gastrostomy tube feedings in children with end stage renal disease. Adv Perit Dial 6:262–264

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  11. 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 

  12. Taylor JM, Oladitan L, Carlson S, Hamilton-Reeves JM (2015) Renal formulas pretreated with medications alters the nutrient profile. Pediatr Nephrol 30:1815–1823

    Article  PubMed  PubMed Central  Google Scholar 

  13. Le Palma K, Pavlick ER, Copelovitch L (2018) Pretreatment of enteral nutrition with sodium polystyrene sulfonate: effective, but beware the high prevalence of electrolyte derangements in clinical practice. Clin Kidney J 11:166–171

    Article  CAS  PubMed  Google Scholar 

  14. Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Huang IZ, Investigators P-H (2011) Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 32:820–828

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, Stasiv Y, Zawadzki R, Berman L, Bushinsky DA, Investigators A-D (2015) Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease: the AMETHYST-DN randomized clinical trial. JAMA 314:151–161

    Article  CAS  PubMed  Google Scholar 

  16. Weir MR, Bakris GL, Bushinsky DA, Mayo MR, Garza D, Stasiv Y, Wittes J, Christ-Schmidt H, Berman L, Pitt B, Investigators O-H (2015) Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med 372:211–221

    Article  CAS  Google Scholar 

  17. Bushinsky DA, Rossignol P, Spiegel DM, Benton WW, Yuan J, Block GA, Wilcox CS, Agarwal R (2016) Patiromer decreases serum potassium and phosphate levels in patients on hemodialysis. Am J Nephrol 44:404–410

    Article  CAS  PubMed  Google Scholar 

  18. Bushinsky DA, Spiegel DM, Gross C, Benton WW, Fogli J, Hill Gallant KM, Du Mond C, Block GA, Weir MR, Pitt B (2016) Effect of patiromer on urinary ion excretion in healthy adults. Clin J Am Soc Nephrol 11:1769–1776

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Russo D, Corrao S, Battaglia Y, Andreucci M, Caiazza A, Carlomagno A, Lamberti M, Pezone N, Pota A, Russo L, Sacco M, Scognamiglio B (2011) Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int 80:112–118

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Dalgleish DG, Law AJR (1989) pH-Induced dissociation of bovine casein micelles. II. Mineral solubilization and its relation to casein release. J Dairy Res 56:727–735

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Funding

This study was funded in full by the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health.

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Correspondence to Neil J. Paloian.

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The authors declare that they have no conflict of interest.

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Paloian, N.J., Bowman, B. & Bartosh, S.M. Treatment of infant formula with patiromer dose dependently decreases potassium concentration. Pediatr Nephrol 34, 1395–1401 (2019). https://doi.org/10.1007/s00467-019-04232-8

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  • DOI: https://doi.org/10.1007/s00467-019-04232-8

Keywords

  • Patiromer
  • Potassium
  • Hyperkalemia
  • Formula