• Kiran Nasir
  • Aasim Ahmad


Background: Hyperkalemia is one of the most dreadful complications of chronic kidney disease (CKD). Medical management includes use of cation exchange resins to reduce the amount of excessive potassium from the body. Sodium polystyrene sulphonate (SPS) and calcium polystyrene sulphonate (CPS) are currently used for hyperklemia of CKD all over the world. The objective was to compare the efficacy and safety of two different cation exchange resins (CPS and SPS) in patients of CKD with hyperkalemia. Methods: This randomized control trial was done at the Kidney Centre, Post Graduate Training Institute (PGTi), Karachi, Pakistan between 15th January 2010 till 31st December 2010 to compare the efficacy and safety of, CPS and SPS in 97 CKD patients with hyperkalemia. The subjects were divided in two groups. Group-A received CPS while group-B received SPS. The data included symptoms, food recall, physical signs of volume overload and electrolytes. After receiving potassium binding resin for 3 days patients were evaluated for symptoms, weight gain, worsening of blood pressure and effect on electrolytes. Adverse events were recorded in an event reporting form. Results: Average potassium level pre resin was 5.8±0.26 in group-A and 5.8±0.6 in group-B, which reduced to 4.8±0.5 in group-A and 4.3±0.53 in group-B suggesting the efficacy of both drugs for treatment of hyperkalemia in CKD patients. Systolic blood pressure remains stable in both the groups while an increase in diastolic blood pressure was noticed in group-B patients (p-value 0.004). No major adverse effect occurred in both the groups. Conclusion: Both CPS and SPS can be used effectively for reducing hyperkalemia of CKD. CPS showed fewer side effects as compared to SPS.Keywords: Hyperkalemia, Chronic Kidney Disease, Cation exchange resin


Einhorn LM, Zhan M, Hsu VD, Walker LD, Moen MF, Seliger SL, et al. The frequency of hyperkalemia and its significance in chronic kidney disease. Arch Intern Med 2009; 169(12):1156–62.

Weiner ID, Wingo CS. Hyperkalemia: A potential silent killer. J Am Soc Nephrol 1998; 9:1535–43.

Tran HA. Extreme hyperkalemia. South Med J 2005;98(7):729–32

Marino PL. Potassium: The ICU Book. Baltimore: Williams & Wilkins; 1998.

Rastergar A, Soleimani M. Hypokalemia and Hyperkalemia. Postgrad Med J 2001;77:759–64.

Suzuki Y. Shinryo to Hoken. Clinic Med 1973;15:1974–76.

Kataoka K. Shinryo to Shinyaku. Medical consultation & new remedies 1973; 10: 1013.

Hirasawa Y. Shinryo to Shinyaku. Medical consultation & new remedies 1973;10:1021.

Berlyne GM, Janabi K, Shaw AB, Hocken AG. Treatment of hyperkalemia with a calcium resin. Lancet. 1966;1:169–72.

Berlyene GM, Shaw AB. Cation exchange resins in hyperkalaemic renal failure. Isr J Med Sci 1967;3:45–52.

Segura J, Ruilope LM. Hyperkalemia risk and treatment of heart failure. Heart Fail Clin. 2008;4(4):455–64.

Khanna A, White WB. The management of hyperkalemia in patients with cardiovascular disease. Am J Med 2009;122(3):215–21.

Evans BM, Jones NC, Milne MD, Yellowlees H. Ion-exchange resins in the treatment of anuria Lancet 1953;2:791–5

Berlyne GM, Janabi, Shaw. Dangers of resonium A in the treatment of hyperkalemia in renal failure. Lancet 1966 Jan 22;1(7430):167–9

Papadimitriou M, Gingell JC, Chisholm GD. Hypercalcemia from calcium ion exchange resin in patients on regular hemodialysis. Lancet 1968;2(7575):948–50

Madias NE, Levey AS. Metabolic alkalosis due to absorption of "nonabsorbable" antacids. Am J Med 1983; 74(1): 155–158.

Schroeder ET. Alkalosis resulting from combined administration of a "nonsystemic" antacid and a cation-exchange resin. Gastroenterology 1969; 56(5): 868–874.

Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW. The effect of dietary protein restriction and blood pressure control on the progression of chronic renal disease. N Engl J Med 1994;330(13):877–84.

Macaulay A. C. Onuigbo. Achieved vs Initial Blood Pressure in Predicting Renal Outcomes. Arch Intern Med 2004;164(2):223.

Gardiner GW. Kayexalate (sodium polystyrene sulphonate) in sorbitol associated with intestinal necrosis in uremic patients. Can J Gastroenterol 1997;11(7):573–7.

Gerstman BB, Kirkman R, Platt R. Intestinal necrosis associated with postoperative orally administered sodium polystyrene sulfonate in sorbitol. Am J Kidney Dis. 1992;20(2):159–61.

Rogers, Frederick B. Acute Colonic Necrosis Associated with Sodium Polystyrene Sulfonate (Kayexalate) Enemas in a Critically Ill Patient: Case Report and Review of the Literature. Journal of Trauma-Injury Infection & Critical Care. 2001;51(2):395–7.