Mogamat-Yazied Chothia
* 
, Ntombizodwa Mpungose
1 Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Abstract
Sodium and calcium polystyrene sulfonate (SPS and CPS) are potassium-binding resins frequently prescribed in the management of hyperkalaemia. We conducted a scoping review to examine the efficacy and safety of polystyrene sulfonates in hospitalised adults with hyperkalaemia and to identify knowledge gaps relevant to clinical practice. This scoping review was conducted following the PRISMA-ScR guidelines. Studies were eligible for inclusion if they reported on the use of SPS or CPS in hospitalised adults for the treatment of hyperkalaemia. Searches were conducted on Medline (PubMed) and the Web of Science Core Collection. The protocol was prospectively registered with the Open Science Framework. In this study, seventeen studies were included, representing 31 treatment arms and 4325 hospitalised adult patients. Overall, the mean baseline serum potassium concentration was 5.8 ± 0.28 mmol/L, with a mean reduction of approximately 1.0 mmol/L. No significant difference was observed between SPS and CPS (0.98 mmol/L versus 0.95 mmol/L; P = 0.829). The median time to nadir serum potassium was 12.5 hours. A moderate negative correlation was observed between polystyrene sulfonate dose and the change in serum potassium concentration (r = -0.462, P = 0.010). SPS dose was significantly correlated with potassium reduction (r = -0.457, P = 0.019), while CPS was not (r=-0.515, P = 0.485). Constipation was the most common gastrointestinal adverse event, occurring most frequently in patients who received CPS. Hypernatraemia, hypocalcaemia and hypoglycaemia were observed only in SPS-treated patients, whereas hypercalcaemia occurred exclusively in those treated with CPS. In this study, we concluded that polystyrene sulfonates showed a modest reduction in serum potassium concentrations in patients who had mild hyperkalaemia regardless of resin type. While gastrointestinal and metabolic adverse events were uncommon, the specific side effects varied according to the type of resin used.
Implication for health policy/practice/research/medical education:
This scoping review of real-world data demonstrates that polystyrene sulfonates effectively reduce serum potassium concentrations in hospitalised patients with mild hyperkalaemia, with no observed differences in efficacy between sodium and calcium formulations. Gastrointestinal and metabolic adverse events were generally uncommon and appeared to vary according to resin type, while bowel-related complications were rare and may be disproportionately emphasised in the literature. Considering the prohibitive costs and limited availability of newer potassium binders, such as patiromer and sodium zirconium cyclosilicate, particularly in low- and middle-income countries, polystyrene sulfonates remain a safe, accessible, and effective therapeutic option for the management of hyperkalaemia.
Please cite this paper as: Chothia MY, Mpungose N. Efficacy and safety of polystyrene sulfonates for the treatment of hyperkalaemia in hospitalised adult patients; a scoping review. J Nephropharmacol. 2027;16(1):e12816. DOI: 10.34172/npj.12816.