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21. New drugs for hyperkalemia

. And these patients have an absolute indication for an ACE-I or ARB. Thus, we have a conundrum. How do we successfully treat their systolic dysfunction or progressive CKD. Drug companies see an niche. Sodium polysterene (Kayexalate) is not adequate due to dangerous side effects. Patiromer (Valtessa) was released first, now this new option. What will be their roles? What will be the pricing? This is all interesting, and we will follow the indications for its use with interest. Share this: Like this: Like Loading

2018 db's Medical Rants blog

22. A Study to Test Whether ZS (Sodium Zirconium Cyclosilicate) Can Reduce the Incidence of Increased Blood Potassium Levels Among Dialized Patients.

Criteria: Involvement in the planning and/or conduct of the study (applies to both AstraZeneca, including ZS Pharma staff and/or staff at the study site) Hemoglobin <9 g/dL on screening (as assessed on Visit 1) Lack of compliance with hemodialysis prescription (both number and duration of treatments) during the two-week period preceding screening (100% compliance required) Patients treated with sodium polystyrene sulfonate (SPS, Kayexalate, Resonium), calcium polystyrene sulfonate (CPS, Resonium

2017 Clinical Trials

23. Pharmacokinetic Study of Tacrolimus and Mycophenolate Mofetil in Kidney Transplant Recipients With Hyperkalemia Receiving Patiromer

with the study. Kidney transplant recipient. Must be receiving MMF for maintenance immunosuppression Must be receiving tacrolimus for maintenance immunosuppression Subjects must have hyperkalemia (serum potassium ≥ 5.0 mEq/L and ≤ 6.0 mEq/L). Prior to enrollment, subjects must be taking a steady dose of tacrolimus for 3 days. Exclusion Criteria: Use of Kayexalate 1 day prior to screening visit. Serum potassium level of greater than 6.0 mEq/L at screening. Serum magnesium level of less than 1.0mg/dL

2017 Clinical Trials

24. ZS Ph2/3 Dose-response Study in Japan

treated with resins (such as sevelamer hydrochloride, sodium polystyrene sulfonate [SPS; e.g. Kayexalate®] or calcium polystyrene sulfonate [CPS]), calcium acetate, calcium carbonate, or lanthanum carbonate, within 7 days prior to the first dose of study drug Patients with a life expectancy of less than 3 months Patients who are severely physically or mentally incapacitated and who, in the opinion of investigator, are unable to perform the patients' tasks associated with the protocol Female patients

2017 Clinical Trials

25. Open-label Safety of Sodium Zirconium Cyclosilicate for up to 12 Months in Japanese Subjects With Hyperkalemia

to first dose of ZS. Patients treated with resins (such as sevelamer hydrochloride, sodium polystyrene sulfonate [SPS; e.g. Kayexalate®] or calcium polystyrene sulfonate [CPS]), calcium acetate, calcium carbonate, or lanthanum carbonate, within 7 days prior to the first dose of study drug. Washout of SPS and CPS for 7 days (or longer) prior to the first dose of ZS is allowed, if termination of CPS or SPS is judged to be clinically acceptable by the investigator. Documented informed consent has

2017 Clinical Trials

26. Novel kyperkalemia treatments – practical points

Novel kyperkalemia treatments – practical points Renal Fellow Network: Novel hyperkalemia treatments – practical points | | | | | Sunday, January 24, 2016 Novel hyperkalemia treatments – practical points I was quite excited to see the development of novel agents to help us manage hyperkalemia in our kidney patients in place of kayexalate, which is extremely unpleasant for patients, is associated with diarrhea and have reported severe side effects such as intestinal necrosis. As previously (...) and constipation. Duration of trials were up to 52 weeks. is a crystalline compound of zirconium silicate that exchanges Na+/H+ for K+. Based on its mechanism of action, patients will have about 300mg of extra Na+ intake per day (Kayexalate has the same issue). The main side effect of ZS9 was edema (~7%). Duration of trial with ZS-9 was only 4 weeks. FDA has not approved ZS9 yet but it is likely that once approved, it will be the leading drug in the market, especially if the black box from FDA remains

2016 Renal Fellow Network

27. Tumor lysis syndrome in an extraskeletal osteosarcoma: a case report and review of the literature (PubMed)

and bilateral hydronephrosis. After spontaneous tumor lysis syndrome, she had acute renal insufficiency, which was treated with hemodialysis and successively with rasburicase, Kayexalate (sodium polystyrene sulfonate), and febuxostat.Tumor lysis syndrome represents an oncological emergency, which must be suspected and treated as soon as possible.

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2017 Journal of medical case reports

28. A Case of Hypophosphatemia with Increased Urinary Excretion of Phosphorus Associated with Ibrutinib (PubMed)

/dl) and potassium (reaching a peak of 6.5 mEq/l). Uric acid and calcium levels were normal. The patient developed hypophosphatemia (prior to initiation of therapy the serum phosphorus was 2.9 mg/dl). No metabolic acidosis was noted. Urinalysis showed no glucosuria or proteinuria. Urinary fraction of excretion of phosphate was found to be 345% (normal <5%). Because of these changes, ibrutinib was held, and the patient was given kayexalate. Serum potassium normalized. Serum phosphorus was checked

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2016 Case reports in oncology

29. Management of life-threatening hyperkalemia

Dodge 1953). You will notice that sodium polystyrene sulfonate (kayexalate) is not included in this treatment plan. The evidence for SPS is extremely poor, but if it has any effect in acute hyperkalemia, that effect is not for many hours and comes with extra risk (colonic necrosis) that is not clearly outweighed by benefit. I never use SPS in the emergency department. Does sodium bicarbonate work? The bicarb bottom line: We really don’t know. The best guess currently is it may be marginally

2016 First10EM

30. Top nephrology-related stories of 2014

buster" drug for hyperkalemia. The company ZS Pharma reported the results of 2 trials, the trial in JAMA and a phase 3 trial in . Both these studies showed efficient potassium lowering versus placebo and rebound once the drug is discontinued. hosted a lively twitter discussion about the HARMONIZE trial. Concerns for how ZS-9 will be tolerated long term and why it was compared to placebo and not kayexalate or diet. Also, in the high dose group more patients had peripheral edema. ZS-9 has the potential

2014 Renal Fellow Network

31. NephMadness 2014 Part 7 - Electrolyte Bracket

NephMadness 2014 Part 7 - Electrolyte Bracket Renal Fellow Network: NephMadness 2014 Part 7 - Electrolyte Bracket | | | | | Sunday, March 23, 2014 NephMadness 2014 Part 7 - Electrolyte Bracket The electrolyte bracket contains a mixture of the old staples of nephrology mixed with some new kids on the block trying to muscle in on established territory, Vaptans vs hypertonic saline and ZS-9 vs Kayexalate. Hypertonic saline is well established and works when used correctly. In my experience

2014 Renal Fellow Network

32. Articles of the month (December 2015)

the posterior aspect of the ear, so you may have difficulty if the injury is more anterior. They can also miss the top of the ear. Bottom line: Nerve blocks are fantastic for many things in the ED, especially when using ultrasound guidance. Don’t have access to this paper? . You could also . We have many effective treatments for hyperkalemia – kayexalate just isn’t one of them Hagan AE, Farrington CA, Wall GC, Belz MM. Sodium polystyrene sulfonate for the treatment of acute hyperkalemia: a retrospective (...) study. Clinical nephrology. 85(1):38-43. 2016. PMID: The evidence behind the use of sodium polystyrene sulfonate (kayexalate) for hyperkalemia is poor. This is a chart review looking at 501 patients who received SPS for hyperkalemia. The chart review methods make it difficult to assess the true effect, but on average after SPS administration, the potassium decreased by 0.93mEq/L. That sounds reasonable, until you realise that the drop occurred over about 8 hours and that most of these patients were

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2015 First10EM

33. Top nephrology-related stories of 2013

of a better potassium binder for treating hyperkalemia. This is a frequently encountered problem with life threatening implications. Sodium polystyrene sulphonate (kayexalate) has been put as of late. Many have been calling into question its effectiveness and potential risks (bowel necrosis). For another view on SPS check out at PBFluids. The company presented results from a phase II clinical trial and demonstrated that ZS-9 was capable of lowering potassium with minimal side effects. This could be a huge

2013 Renal Fellow Network

34. Colesevelam and Colestipol: Novel Medication Resins in the Gastrointestinal Tract. (PubMed)

) and lacked internal "fish-scales." To validate these observations, respective medications were submitted for histologic processing; the processed medications were identical to those in the patient specimens. Rare, irregular "fracture" lines presented diagnostic pitfalls by mimicking the true "fish-scales" of Kayexalate and sevelamer. Clues to the correct identification of BAS include recognition that the "fracture" lines were subtle, irregular, and restricted to large fragments or thick sections, likely (...) representing a processing artifact. Moreover, Kayexalate is violet on H&E and black on acid fast bacillus, and sevelamer characteristically displays a 2-tone color on H&E and is magenta on acid fast bacillus. An association with inflammatory injury was seen (15/26). We believe that the BAS are innocent bystanders in complicated patients, although we cannot exclude their ability to cause mucosal injury in specific settings.

2014 American Journal of Surgical Pathology

35. Monocentric STUDY, Randomised Double Blinded (Healthy Subjects, or Transversal (Patients With Gitelman Syndrome)

will be submitted twice to two periods of normal Na+/ high K+ diet (control period) followed by a normal Na+/ low K+ diet sustained by a pharmacological treatment with Kayexalate (K+-depleted condition). The subjects will be treated with either RU486 or a placebo, according to a randomization. The adrenal response will be evaluated after stimulation by Synacthen at baseline and at the end of each experimental period. A Synacthen test will be also done in 10 patients suffering of chronic hypokalemia linked

2014 Clinical Trials

36. Efficacy of Sodium Polystyrene Sulfonate in the Treatment of Hyperkaliemia in Pre-dialysis Patients

/treatment Active Comparator: Sodium Polystyrene Sulfonate 30 g sodium polystyrene sulfonate powder, mixed with water qs ad 150 ml, taken PO once daily for seven days Drug: Sodium polystyrene sulfonate Other Names: SPS Kayexalate Solystat Placebo Comparator: Lactose with carob gum 30 g placebo powder, mixed with water qs ad 150 ml, taken PO once daily for seven days Drug: Lactose with carob gum Other Name: Placebo Outcome Measures Go to Primary Outcome Measures : Change in serum potassium levels from (...) provided by Dr. Vincent Pichette, Maisonneuve-Rosemont Hospital: Sodium Polystyrene Sulfonate Kayexalate Pre-dialysis Outpatients Hyperkalemia Chronic kidney failure Potassium Additional relevant MeSH terms: Layout table for MeSH terms Renal Insufficiency Hyperkalemia Kidney Failure, Chronic Kidney Diseases Urologic Diseases Water-Electrolyte Imbalance Metabolic Diseases Renal Insufficiency, Chronic Polystyrene sulfonic acid Chelating Agents Sequestering Agents Molecular Mechanisms of Pharmacological

2014 Clinical Trials

37. Safety & Efficacy of Zirconium Silicate Dosed for 28 Days in Hyperkalemia.

of severe leukocytosis or thrombocytosis. Subjects treated with lactulose, Xifaxan or other non-absorbed antibiotics for hyperammonemia within 7 days prior to the first dose of study drug. Subjects treated with resins (such as sevelamer acetate or sodium polystyrene sulfonate [SPS; e.g. Kayexalate®]), calcium acetate, calcium carbonate, or lanthanum carbonate, within 7 days prior to the first dose of study drug. Subjects with a life expectancy of less than 3 months. Subjects who are severely physically

2014 Clinical Trials

38. Open-label Safety and Efficacy of Sodium Zirconium Cyclosilicate for up to 12 Months Including Randomized Withdrawal

or traumatic venipuncture, or history of severe leukocytosis or thrombocytosis. Subjects treated with lactulose, rifaximin, or other non-absorbed antibiotics for hyperammonemia within 7 days prior to first dose of ZS on Acute Phase Study Day 1. Subjects treated with sodium polystyrene sulfonate (SPS; eg, Kayexalate®) or calcium polystyrene sulfonate (eg, Resonium®) within 3 days prior to first dose of ZS on Acute Phase Study Day 1. Subjects with a life expectancy of less than 12 months. Subjects who

2014 Clinical Trials

39. Evaluation of Gut Bacteria in Patients With Polycystic Kidney Disease

. Patients with PKD. Patients are able to understand and give consent. Exclusion Criteria: Patient on antibiotics or vitamin supplement (except vitamin D analogs) in the last three months. Advanced liver disease, advanced cardiovascular disease, heart failure with EF < 30%, and autoimmune disease. The use of chemotherapy, antibiotics, immunosuppressive medications, probiotics, and steroid in the last three month. Intravenous or oral iron supplementation, laxatives, and kayexalate in the last month

2014 Clinical Trials

40. Fluid, Electrolyte, and Nutrition Management of the Newborn (Diagnosis)

to enhance potassium excretion, including IV furosemide 1mg/kg or rectally administered sodium polystyrene sulfonate (Kayexalate) 1g/kg (do not use sorbitol-containing products and do not administer orally). Several hours must pass before any effect is observed with either of these medications. Dialysis or exchange transfusion may be used to assist in more rapidly removing potassium from the body. Hypercalcemia and hypocalcemia Total serum calcium levels in term infants decline from values of 10-11mg/dL

2014 eMedicine Pediatrics

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