Clinical and Experimental Gastroenterology (Jan 2021)
Adverse Gastrointestinal Effects with Kayexalate or Kalimate: A Comprehensive Review
Abstract
Yi-Hua Wu,1 Jen-Wei Chou,1– 4 Hsiang-Chun Lai,5 Gin-Shen Su,1 Ken-Sheng Cheng,1,2 Tsung-Wei Chen6 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 2School of Medicine, China Medical University Hospital, Taichung, Taiwan; 3Taiwan Society of Inflammatory Bowel Disease, Taipei, Taiwan; 4Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan; 5Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; 6Department of Pathology, Asia University Hospital, Taichung, TaiwanCorrespondence: Jen-Wei Chou Division of Gastroenterology and Hepatology, Department of Internal Medicine. China Medical University Hospital, No. 2, Yude Road, North District, Taichung 40447, TaiwanTel + 886-4-22052121 ext. 2220Fax +886-4-22023119Email [email protected]: Patients with hyperkalemia are commonly treated with Kayexalate or Kalimate. Both drugs are associated with some fatal gastrointestinal (GI) adverse events (AEs).Aim: To assess the clinical characteristics and outcomes of GI AEs induced by Kayexalate or Kalimate from published case reports.Methods: We conducted a systematic review of case reports of Kayexalate or Kalimate-induced GI AEs, from PubMed, Medline, Cochrane Library, Clinical Key, and Google Scholar databases (1948 to March 31, 2020). We analyzed the clinical characteristics, GI AEs, and risk factors of enrolled patients.Results: We identified 41 published articles describing 135 cases of GI AEs induced by Kayexalate (103 cases) or Kalimate (32 cases). The mean age of all patients was 55.5 years. Most patients were male (54.8%). As high as 55.6% preparations were administered with sorbitol whereas 44.4% preparations had no sorbitol. The average time causing GI AEs was 19.8 days. Colon was the most commonly affected site (76.3%). Drug crystals were histopathologically proven in 95.5% of the patients. Meanwhile, mortality was reported in 20.7%.Conclusion: Kayexalate or Kalimate, without or with sorbitol combination, may be related to fatal GI damage. Uremia, hypertension, and transplantation are predisposing factors. Clinicians should be careful in prescribing Kayexalate or Kalimate to patients.Keywords: gastrointestinal injury, hyperkalemia, Kayexalate, Kalimate
