Cation-Exchange Resins Such As Kayexalate In The Treatment of Acute Hyperkalemia.

This month JC is going to attempt to review the evidence regarding the use of cation-exchange resins such as Kayexalate in the treatment of acute hyperkalemia. We will look at two historical studies that are the basis upon our use of kayexylate in acute hyperkalemia that actually date back to (believe it or not) 1961. In addition, we will look at a two systematic reviews that describe current best evidence for the treatment of acute hyperkalemia. There is a Cochrane Review that is too lengthy to include in the package and I will provide a link here.  Included in the package, is a systematic review from CMAJ that we will discuss. Both Cochrane and the CMAJ articles are from the folks who continue to set the “gold standard” for EBM, McMaster University in Hamilton, Ontario. In addition, I included a piece on having family members present during CPR and we will be interested in the group’s thoughts and comments on this study and you practices in general.      

PICO Question

Population: Adult emergency department patients with life-threatening hyperkalemia.

Intervention: Treatment with gastrointestinal cation-exchange resin (kayexalate) plus other potassium lower regimensl

Comparison: Treatment with potassium lower regimens other than cation-exchange resins

Outcome: Hyperkalemia-related mortality, duration of hyperkalemia, adverse effects attributed to kayexalate. 

Flinn RB, Merrill JP, Welzan WR: Treatment of the oliguric patient with a new sodium ion- exchange resin and sorbitol: A preliminary report. N Engl J Med 264: 111–115, 1961 Appraisal

Scherr L, Ogden DA, Mead AW, Spritz N,
Rubin AL: Management of hyperkalemia 2001 with a cation-exchange resin. N Engl J Med 264: 115–119, 1961 Appraisal

Meghan J. Elliott, Paul E. Ronksley, CMAJ October 19, 2010 Management of patients with acute hyperkalemia CMAJ October 19, 2010 

Mahoney BA, Smith WA, Lo DS, Tsoi K, Tonelli M, Emergency interventions for hyperkalaemia. Cochrane Database Syst Rev. 2005 Apr 18;(2) Wash U EM Appraisal

Jabre P, Belpomme V, et al Family Presence During Cardiopulmonary Resuscitation N Engl J Med. 368(11):1008-18 2013 Mar 14;