Add-on Therapy of Potassium-exchange Resin for Hyperkalemia in Chronic Kidney Disease Patients on Renin-angiotensin System Blockers

Korean Journal of Nephrology 2007;26(5):534-540.

Joo-Hark Yi, M.D., Yeo-Wook Yun, M.D., Useok Noh, M.D., Eun-Young Kim, M.D. Jae-Il Park, M.D., Sang-Woong Han, M.D. and Ho-Jung Kim, M.D.

Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea

만성 신장병 환자에서 레닌-안지오텐신계 억제제와 칼륨교환수지 동시 사용이 혈청 칼륨에 미치는 영향

이주학 윤여욱 노유석 김은영 박재일 한상웅 김호중

한양대학교 의과대학 내과학교실

Abstract

Purpose : This prospective study aimed to evaluate the safety and efficacy of potassium-exchange resin (PER, Kalimateⓡ or Argamateⓡ) for managing hyperkalemia induced by Renin-Angiotensin System (RAS) blockers in chronic kidney disease (CKD) patients without their discontinuation. Methods : Besides conservative remedies including low-potassium diet, all hyperkalemic CKD patients (n=21, [K] ≥5.6 mEq/L) received PER added on angiotensin-converting enzyme inhibitor (Moexipril, n=2) or angiotensin-receptor blocker (Irbesartan, n=19) with, at least, weekly monitoring of serum [K] if its level remains more than 5.5 mEq/L for more than 2 months (mean±SD, 6.8±5.9 mon; range, 2-26 mon). Results : Baseline serum [K] on RAS blocker alone (5.1±0.4 mEq/L; 4.2-6.3 mEq/L) increased to 6.0 ±0.4 mEq/L (p<0.05) before adding PER, and then it was significantly decreased to 5.3±0.6 mEq/L at the first clinic visit (p<0.05) and to 5.0±0.7 mEq/L at the last clinic visit (p<0.05) following the administration of PER added on RAS blocker. During the study period, GFR, serum creatinine and urinary protein excretion didn't change significantly. Conclusion : The development of hyperkalemia on RAS blockers in CKD patients doesn't necessarily lead to withdrawal of RAS blockers when the cautious add-on therapy of potassium-exchange resin with other conservative remedies launches, unless severe refractory hyperkalemia persists.

Key Words: Hyperkalemia, Renal insufficiency, Angiotensin-converting enzyme inhibitors, Angiotensin II type 1 r