Skip to main content
Top
Published in: Pediatric Nephrology 8/2019

01-08-2019 | Chronic Kidney Disease | Original Article

Treatment of infant formula with patiromer dose dependently decreases potassium concentration

Authors: Neil J. Paloian, Barbara Bowman, Sharon M. Bartosh

Published in: Pediatric Nephrology | Issue 8/2019

Login to get access

Abstract

Background

Hyperkalemia is a potentially life-threatening complication of chronic kidney disease (CKD). Dietary potassium restriction is challenging in infants despite low-potassium formulas. Decreasing potassium in formula using patiromer, a new calcium-based cation exchange polymer may be one option to accomplish this; however, data confirming efficacy is lacking.

Methods

Varying doses of patiromer were added to prepared Similac Advance and Similac PM 60/40. Measurements of potassium, calcium, sodium, magnesium, and phosphorus were obtained at baseline and at 30 min, 60 min, and 24 h following patiromer administration.

Results

Following pre-treatment with patiromer, the potassium concentration of both formulas decreased. This effect was mild with the lowest dose but increased in a dose-dependent fashion. Treating for 60 min or 24 h did not yield substantially greater effects than treating for 30 min. Calcium levels increased in both formula groups, mostly in a dose-dependent fashion. Changes in magnesium, sodium, and phosphorus were also seen after patiromer pre-treatment.

Conclusions

Pre-treatment with patiromer decreases the potassium concentration of infant formula. Calcium levels increased after treatment as expected with the majority of ion exchange occurring in 30 min. Treatment of formula with patiromer shows promise as a unique option for managing hyperkalemia.
Literature
1.
go back to reference Furth SL, Abraham AG, Jerry-Fluker J, Schwartz GJ, Benfield M, Kaskel F, Wong C, Mak RH, Moxey-Mims M, Warady BA (2011) Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease. Clin J Am Soc Nephrol 6:2132–2140CrossRefPubMedPubMedCentral Furth SL, Abraham AG, Jerry-Fluker J, Schwartz GJ, Benfield M, Kaskel F, Wong C, Mak RH, Moxey-Mims M, Warady BA (2011) Metabolic abnormalities, cardiovascular disease risk factors, and GFR decline in children with chronic kidney disease. Clin J Am Soc Nephrol 6:2132–2140CrossRefPubMedPubMedCentral
2.
go back to reference Wong H, Mylrea K, Feber J, Drukker A, Filler G (2006) Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 70:585–590CrossRefPubMed Wong H, Mylrea K, Feber J, Drukker A, Filler G (2006) Prevalence of complications in children with chronic kidney disease according to KDOQI. Kidney Int 70:585–590CrossRefPubMed
3.
go back to reference Group KW (2009) KDOQI clinical practice guideline for nutrition in children with CKD: 2008 update. Executive summary. Am J Kidney Dis 53:S11–S104 Group KW (2009) KDOQI clinical practice guideline for nutrition in children with CKD: 2008 update. Executive summary. Am J Kidney Dis 53:S11–S104
4.
go back to reference Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D (2006) Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol 21:793–799CrossRefPubMed Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D (2006) Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol 21:793–799CrossRefPubMed
5.
go back to reference Scherr L, Ogden DA, Mead AW, Spritz N, Rubin AL (1961) Management of hyperkalemia with a cation-exchange resin. N Engl J Med 264:115–119CrossRefPubMed Scherr L, Ogden DA, Mead AW, Spritz N, Rubin AL (1961) Management of hyperkalemia with a cation-exchange resin. N Engl J Med 264:115–119CrossRefPubMed
6.
go back to reference Ohlsson A, Hosking M (1987) Complications following oral administration of exchange resins in extremely low-birth-weight infants. Eur J Pediatr 146:571–574CrossRefPubMed Ohlsson A, Hosking M (1987) Complications following oral administration of exchange resins in extremely low-birth-weight infants. Eur J Pediatr 146:571–574CrossRefPubMed
7.
go back to reference Filippi L, Cecchi A, Dani C, Bertini G, Pezzati M, Rubaltelli FF (2004) Hypernatraemia induced by sodium polystyrene sulphonate (Kayexalate) in two extremely low birth weight newborns. Paediatr Anaesth 14:271–275CrossRefPubMed Filippi L, Cecchi A, Dani C, Bertini G, Pezzati M, Rubaltelli FF (2004) Hypernatraemia induced by sodium polystyrene sulphonate (Kayexalate) in two extremely low birth weight newborns. Paediatr Anaesth 14:271–275CrossRefPubMed
8.
go back to reference Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM (2013) Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med 126:264 e269–264 e224CrossRef Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM (2013) Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med 126:264 e269–264 e224CrossRef
9.
go back to reference Wood EG, Bunchman TE, Khurana R, Fleming SS, Lynch RE (1990) Complications of nasogastric and gastrostomy tube feedings in children with end stage renal disease. Adv Perit Dial 6:262–264PubMed Wood EG, Bunchman TE, Khurana R, Fleming SS, Lynch RE (1990) Complications of nasogastric and gastrostomy tube feedings in children with end stage renal disease. Adv Perit Dial 6:262–264PubMed
10.
go back to reference Thompson K, Flynn J, Okamura D, Zhou L (2013) Pretreatment of formula or expressed breast milk with sodium polystyrene sulfonate (Kayexalate((R))) as a treatment for hyperkalemia in infants with acute or chronic renal insufficiency. J Ren Nutr 23:333–339CrossRefPubMed Thompson K, Flynn J, Okamura D, Zhou L (2013) Pretreatment of formula or expressed breast milk with sodium polystyrene sulfonate (Kayexalate((R))) as a treatment for hyperkalemia in infants with acute or chronic renal insufficiency. J Ren Nutr 23:333–339CrossRefPubMed
11.
go back to reference Bunchman TE, Wood EG, Schenck MH, Weaver KA, Klein BL, Lynch RE (1991) Pretreatment of formula with sodium polystyrene sulfonate to reduce dietary potassium intake. Pediatr Nephrol 5:29–32CrossRefPubMed Bunchman TE, Wood EG, Schenck MH, Weaver KA, Klein BL, Lynch RE (1991) Pretreatment of formula with sodium polystyrene sulfonate to reduce dietary potassium intake. Pediatr Nephrol 5:29–32CrossRefPubMed
12.
go back to reference Taylor JM, Oladitan L, Carlson S, Hamilton-Reeves JM (2015) Renal formulas pretreated with medications alters the nutrient profile. Pediatr Nephrol 30:1815–1823CrossRefPubMedPubMedCentral Taylor JM, Oladitan L, Carlson S, Hamilton-Reeves JM (2015) Renal formulas pretreated with medications alters the nutrient profile. Pediatr Nephrol 30:1815–1823CrossRefPubMedPubMedCentral
13.
go back to reference Le Palma K, Pavlick ER, Copelovitch L (2018) Pretreatment of enteral nutrition with sodium polystyrene sulfonate: effective, but beware the high prevalence of electrolyte derangements in clinical practice. Clin Kidney J 11:166–171CrossRefPubMed Le Palma K, Pavlick ER, Copelovitch L (2018) Pretreatment of enteral nutrition with sodium polystyrene sulfonate: effective, but beware the high prevalence of electrolyte derangements in clinical practice. Clin Kidney J 11:166–171CrossRefPubMed
14.
go back to reference Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Huang IZ, Investigators P-H (2011) Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 32:820–828CrossRefPubMedPubMedCentral Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Huang IZ, Investigators P-H (2011) Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J 32:820–828CrossRefPubMedPubMedCentral
15.
go back to reference Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, Stasiv Y, Zawadzki R, Berman L, Bushinsky DA, Investigators A-D (2015) Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease: the AMETHYST-DN randomized clinical trial. JAMA 314:151–161CrossRefPubMed Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, Stasiv Y, Zawadzki R, Berman L, Bushinsky DA, Investigators A-D (2015) Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease: the AMETHYST-DN randomized clinical trial. JAMA 314:151–161CrossRefPubMed
16.
go back to reference Weir MR, Bakris GL, Bushinsky DA, Mayo MR, Garza D, Stasiv Y, Wittes J, Christ-Schmidt H, Berman L, Pitt B, Investigators O-H (2015) Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med 372:211–221CrossRef Weir MR, Bakris GL, Bushinsky DA, Mayo MR, Garza D, Stasiv Y, Wittes J, Christ-Schmidt H, Berman L, Pitt B, Investigators O-H (2015) Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med 372:211–221CrossRef
17.
go back to reference Bushinsky DA, Rossignol P, Spiegel DM, Benton WW, Yuan J, Block GA, Wilcox CS, Agarwal R (2016) Patiromer decreases serum potassium and phosphate levels in patients on hemodialysis. Am J Nephrol 44:404–410CrossRefPubMed Bushinsky DA, Rossignol P, Spiegel DM, Benton WW, Yuan J, Block GA, Wilcox CS, Agarwal R (2016) Patiromer decreases serum potassium and phosphate levels in patients on hemodialysis. Am J Nephrol 44:404–410CrossRefPubMed
18.
go back to reference Bushinsky DA, Spiegel DM, Gross C, Benton WW, Fogli J, Hill Gallant KM, Du Mond C, Block GA, Weir MR, Pitt B (2016) Effect of patiromer on urinary ion excretion in healthy adults. Clin J Am Soc Nephrol 11:1769–1776CrossRefPubMedPubMedCentral Bushinsky DA, Spiegel DM, Gross C, Benton WW, Fogli J, Hill Gallant KM, Du Mond C, Block GA, Weir MR, Pitt B (2016) Effect of patiromer on urinary ion excretion in healthy adults. Clin J Am Soc Nephrol 11:1769–1776CrossRefPubMedPubMedCentral
19.
go back to reference Russo D, Corrao S, Battaglia Y, Andreucci M, Caiazza A, Carlomagno A, Lamberti M, Pezone N, Pota A, Russo L, Sacco M, Scognamiglio B (2011) Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int 80:112–118CrossRefPubMedPubMedCentral Russo D, Corrao S, Battaglia Y, Andreucci M, Caiazza A, Carlomagno A, Lamberti M, Pezone N, Pota A, Russo L, Sacco M, Scognamiglio B (2011) Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis. Kidney Int 80:112–118CrossRefPubMedPubMedCentral
20.
go back to reference Dalgleish DG, Law AJR (1989) pH-Induced dissociation of bovine casein micelles. II. Mineral solubilization and its relation to casein release. J Dairy Res 56:727–735 Dalgleish DG, Law AJR (1989) pH-Induced dissociation of bovine casein micelles. II. Mineral solubilization and its relation to casein release. J Dairy Res 56:727–735
Metadata
Title
Treatment of infant formula with patiromer dose dependently decreases potassium concentration
Authors
Neil J. Paloian
Barbara Bowman
Sharon M. Bartosh
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 8/2019
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-019-04232-8

Other articles of this Issue 8/2019

Pediatric Nephrology 8/2019 Go to the issue