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KMID : 0359920070260050534
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Korean Journal of Nephrology
2007 Volume.26 No. 5 p.534 ~ p.540
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Add-on Therapy of Potassium-exchange Resin for Hyperkalemia in Chronic Kidney Disease Patients on Renin-angiotensin System Blockers
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Yi Joo-Hark
Yun Yeo-Wook
Noh U-Seok
Kim Eun-Young
Park Jae-Il
Han Sang-Woong
Kim Ho-Jung
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Abstract
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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.
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KEYWORD
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Hyperkalemia, Renal insufficiency, Angiotensin-converting enzyme inhibitors, Angiotensin II type 1 r
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