Clinical and Experimental Nephrology

, Volume 22, Issue 1, pp 35–44 | Cite as

Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia

  • Yosuke Nakayama
  • Kaoru Ueda
  • Sho-ichi Yamagishi
  • Miki Sugiyama
  • Chika Yoshida
  • Yuka Kurokawa
  • Nao Nakamura
  • Tomofumi Moriyama
  • Goh Kodama
  • Tomohisa Minezaki
  • Sakuya Ito
  • Akiko Nagata
  • Kensei Taguchi
  • Junko Yano
  • Yusuke Kaida
  • Kazutaka Shibatomi
  • Kei FukamiEmail author
Original article



Hyperkalemia is prevalent in end-stage renal disease patients, being involved in life-threatening arrhythmias. Although polystyrene sulfonate (PS) is commonly used for the treatment of hyperkalemia, direct comparison of effects between calcium and sodium PS (CPS and SPS) on mineral and bone metabolism has not yet been studied.


In a randomized and crossover design, 20 pre-dialysis patients with hyperkalemia (>5 mmol/l) received either oral CPS or SPS therapy for 4 weeks.


After 4-week treatments, there was no significant difference of changes in serum potassium (K) from the baseline (ΔK) between the two groups. However, SPS significantly decreased serum calcium (Ca) and magnesium (Mg) and increased intact parathyroid hormone (iPTH) values, whereas CPS reduced iPTH. ΔiPTH was inversely correlated with ΔCa and ΔMg (r = −0.53 and r = −0.50, respectively). Furthermore, sodium (Na) and atrial natriuretic peptide (ANP) levels were significantly elevated in patients with SPS, but not with CPS, whereas ΔNa and ΔANP were significantly correlated with each other in all the patients. We also found that ΔNa and Δ(Na to chloride ratio) were positively correlated with ΔHCO3 . In artificial colon fluid, CPS increased Ca and decreased Na. Furthermore, SPS greatly reduced K, Mg, and NH3.


Compared with SPS, CPS may be safer for the treatment of hyperkalemia in pre-dialysis patients, because it did not induce hyperparathyroidism or volume overload.


Chronic kidney disease Potassium Calcium Sodium Hyperkalemia Secondary hyperparathyroidism 



This work was supported, in part, by Grants-in-Aid for Welfare and Scientific Research (C) (no. 16k09637) (K.F) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Compliance with ethical standards

Conflict of interest

Dr. Fukami has received honoraria such as lecture fees from Sanwa (Sanwa Kagaku Kenkyusyo). This paper has not been published previously in whole or part.

Human rights

(with IRB approval number) All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee at which the studies were conducted (Approval No. 13170) and with the 1964 Helsinki Declaration and its later amendments of comparable ethical standards. This trial was registered with the University Hospital Medical Information Network clinical trials database (UMIN 000021955).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Yosuke Nakayama
    • 1
  • Kaoru Ueda
    • 1
    • 2
  • Sho-ichi Yamagishi
    • 3
  • Miki Sugiyama
    • 1
  • Chika Yoshida
    • 1
  • Yuka Kurokawa
    • 1
  • Nao Nakamura
    • 1
  • Tomofumi Moriyama
    • 1
  • Goh Kodama
    • 1
  • Tomohisa Minezaki
    • 1
  • Sakuya Ito
    • 1
  • Akiko Nagata
    • 1
  • Kensei Taguchi
    • 1
  • Junko Yano
    • 1
  • Yusuke Kaida
    • 1
  • Kazutaka Shibatomi
    • 2
  • Kei Fukami
    • 1
    Email author
  1. 1.Division of Nephrology, Department of MedicineKurume University School of MedicineKurumeJapan
  2. 2.Department of Rheumatology and NephrologyOita Prefectural HospitalOitaJapan
  3. 3.Department of Pathophysiology and Therapeutics of Diabetic Vascular ComplicationsKurume University School of MedicineKurumeJapan

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