Hyperkalemia management in children with chronic kidney disease

Abstract

Background. Hyperkalemia is the most common electrolyte disorder in patients with kidney disease, especially with chronic kidney disease (CKD), diabetes mellitus, heart failure, or in those who are treated with renin-angiotensin-aldosterone system antagonists. Objective: to study the prevalence of hyperkalemia in children with CKD stage 1–5 and introduce a phased approach using potassium binder sodium polystyrene sulfonate (SPS) to treat hyperkalemia. Materials and methods. In 300 blood samples of children with CKD stage 1–5, the level of serum potassium (SP) was determined. In 23 patients with CKD stage 1–5, the efficacy and tolerability of SPS for the correction of hyperkalemia was stu­died. SPS was administered orally at the rate of 1 g/kg body weight per day in 3 divided doses. The course of treatment lasted 4 weeks with the subsequent transition to maintenance therapy at a dose of 0.5 g/kg body weight. Results. The results showed that 73.3 % of children with CKD stage 1–5 had normokalemia (SP level of 3.5–5.4 mmol/l). The range of SP values of 5.0–5.4 mmol/l was determined in 60 patients (20.0 %) with CKD stage 1–5. Mild hyperkalemia (5.5–5.9 mmol/l) was recorded in 13.7 % of children with CKD stage 1–5, moderate (6.0–6.4 mmol/l) — in 7 % and severe hyperkalemia (≥ 6.5 mmol/l) — in 6 %. After 4 weeks of treatment with SPS, SP level decreased from 5.9 ± 0.4 mmol/l to 4.7 ± 0.3 mmol/l (p < 0.05). The use of SPS was accompanied by a slight increase in serum sodium levels (from 138.3 ± 2.4 mmol/l to 140.7 ± 2.2 mmol/l), which was within the normal range. SPS therapy was well tolerated, only 1 out of 23 patients stopped taking SPS due to gastrointestinal intolerance. Conclusions. Imbalance in the level of SP in children with CKD stage 1–5 begins with thre­shold values of 5.0–5.4 mmol/l, which requires careful monitoring and timely phased approach in order to control hyperkalemia progression and minimize the occurrence of adverse outcomes. SPS, a potassium binder, is an effective medication that can be used to reduce consistently and safely the level of SP in children with CKD and hyperkalemia as a part of comprehensive therapy.