According to the results of a recently published population-based cohort study, sodium polystyrene sulfonate should be used cautiously as it was found to be associated with an increased risk of hospitalization due to serious gastrointestinal (GI) events in patients of advanced age.

Sodium polystyrene sulfonate is a potassium binder indicated for the treatment of hyperkalemia. In order to determine the association between its use and the risk of hospitalization due to GI events, study authors retrospectively analyzed patient characteristics, prescription data, and outcome data obtained from linked data sets at the Institute for Clinical Evaluative Sciences.

Adults ≥66 years old who received sodium polystyrene sulfonate in an outpatient setting between April 1, 2003 and September 30, 2015 were included in the analysis. “The primary outcome was a composite of adverse GI events (hospitalization or emergency department visit with intestinal ischemia/thrombosis, GI ulceration/perforation, or resection/ostomy) within 30 days of initial sodium polystyrene sulfonate prescription,” the study authors explained.

Of the total 1,853,866 eligible adults identified, 27,704 patients were dispensed sodium polystyrene sulfonate (average [SD] age: 78.5 [7.7] years; 54.7% male); 20,020 users of sodium polystyrene sulfonate were matched to 20,020 nonusers.


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Findings of the study revealed that patients who used sodium polystyrene sulfonate were at an increased risk of an adverse GI event 30 days following administration compared with nonusers. The study authors reported a total of 37 events in users of sodium polystyrene sulfonate (0.2%; incidence rate: 22.97 per 1000 person-years) compared with 18 events in nonusers (0.1%; incidence rate: 11.01 per 1000 person-years) (hazard ratio [HR] 1.94; 95% CI: 1.10, 3.41).

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The association between sodium polystyrene sulfonate use and adverse GI events persisted in a subpopulation analysis limited to patients with baseline laboratory values and matched for eGFR as well as serum potassium level (HR: 2.91; 95% CI: 1.38, 6.12). Findings of the study also revealed intestinal ischemia/thrombosis to be the most common GI injury subtype (HR: 4.92; 95% CI: 1.09, 22.25).

“Our large, population level retrospective matched cohort study investigating GI outcomes in outpatients receiving sodium polystyrene sulfonate found a significant and consistent association of serious adverse GI events with use of the drug,” the study authors concluded. They added, “These findings require confirmation and suggest that clinicians should exercise caution in prescribing sodium polystyrene sulfonate.”

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