Binding Potassium to Improve Treatment With Renin-Angiotensin-Aldosterone System Inhibitors: Results From Multiple One-Stage Pairwise and Network Meta-Analyses of Clinical Trials

  1. Lizaraso-Soto, Frank 12
  2. Gutiérrez-Abejón, Eduardo 13
  3. Bustamante-Munguira, Juan 4
  4. Martín-García, Débora 4
  5. Chimeno, María Montserrat 5
  6. Nava-Rebollo, Álvaro 5
  7. Maurtua-Briseño-Meiggs, Álvaro 6
  8. Fernández-Zoppino, Darío 7
  9. Bustamante-Munguira, Elena 4
  10. de Paz, Félix Jesús 1
  11. Grande-Villoria, Jesús 5
  12. Ochoa-Sangrador, Carlos 8
  13. Pascual, Manuel 9
  14. Álvarez, F. Javier 14
  15. Herrera-Gómez, Francisco 15910
  1. 1 Universidad de Valladolid
    info

    Universidad de Valladolid

    Valladolid, España

    ROR https://ror.org/01fvbaw18

  2. 2 Universidad de San Martín de Porres
    info

    Universidad de San Martín de Porres

    Lima, Perú

    ROR https://ror.org/03deqdj72

  3. 3 Technical Direction of Pharmaceutical Assistance, Gerencia Regional de Salud de Castilla y León
  4. 4 Hospital Universitario de Valladolid
    info

    Hospital Universitario de Valladolid

    Valladolid, España

    ROR https://ror.org/04fffmj41

  5. 5 Hospital Virgen de la Concha
    info

    Hospital Virgen de la Concha

    Zamora, España

    ROR https://ror.org/02bhk3j29

  6. 6 Woodland Medical Practice—NHS
  7. 7 Universidad de Burgos
    info

    Universidad de Burgos

    Burgos, España

    ROR https://ror.org/049da5t36

  8. 8 Clinical Epidemiology Support Office, Sanidad de Castilla y León
  9. 9 University of Lausanne
    info

    University of Lausanne

    Lausana, Suiza

    ROR https://ror.org/019whta54

  10. 10 Castile and León's Research Consolidated Unit n° 299
Journal:
Frontiers in Medicine

ISSN: 2296-858X

Year of publication: 2021

Volume: 8

Type: Article

DOI: 10.3389/fmed.2021.686729 GOOGLE SCHOLAR

Abstract

This manuscript presents findings from the first dichotomous data pooling analysis on clinical trials (CT) regarding the effectiveness of binding potassium. The results emanated from pairwise and network meta-analyses aiming evaluation of response to commercial potassium-binding polymers, that is, to achieve and maintain normal serum potassium (n = 1,722), and the association between this response and an optimal dosing of renin-angiotensin-aldosterone system inhibitors (RAASi) needing individuals affected by heart failure (HF) or resistant hypertension, who may be consuming other hyperkalemia-inducing drugs (HKID) (e.g., β-blockers, heparin, etc.), and frequently are affected by chronic kidney disease (CKD) (n = 1,044): According to the surface under the cumulative ranking area (SUCRA), sodium zirconium cyclosilicate (SZC) (SUCRA >0.78), patiromer (SUCRA >0.58) and sodium polystyrene sulfonate (SPS) (SUCRA <0.39) were different concerning their capacity to achieve normokalemia (serum potassium level (sK+) 3.5–5.0 mEq/L) or acceptable kalemia (sK+ ≤ 5.1 mEq/L) in individuals with hyperkalemia (sK+ >5.1 mEq/L), and, when normokalemia is achieved, patiromer 16.8–25.2 g/day (SUCRA = 0.94) and patiromer 8.4–16.8 g/day (SUCRA = 0.41) can allow to increase the dose of spironolactone up to 50 mg/day in subjects affected by heart failure (HF) or with resistant hypertension needing treatment with other RAASi. The potential of zirconium cyclosilicate should be explored further, as no data exists to assess properly its capacity to optimize dosing of RAASi, contrarily as it occurs with patiromer. More research is also necessary to discern between benefits of binding potassium among all type of hyperkalemic patients, for example, patients with DM who may need treatment for proteinuria, patients with early hypertension, etc.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020185614, CRD42020185558, CRD42020191430.

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