Laboratory Tests

Increased serum potassium levels

Sodium polystyrene sulfonate (SPS, 15-30 gorally or rectally), a sodium-potassium exchange resin, promotes potassium excretion from the GI tract. The onset of action is within 2 hours after administration of SPS, but the maximum effect on potassium levels may not be seen for up to 6 hours, which limits the utility in patients with severe hyperkalemia. Of note, loop diuretics are often used to decrease potassium levels in patients with normal or mildly decreased kidney function, but are not useful in patients with stage 5 CKD to decrease potassium concentrations. Fludrocortisone is a mineralocorticoid that mimics the effects of aldosterone and increases potassium excretion in the distal tubules and through the GI tract. However, fludrocortisone causes significant sodium and water retention, which exacerbates edema and hypertension, and may not be tolerated by many CKD patients.

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