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Sodium polystyrene sulfonate (SPS; Kayexalate) works by exchanging potassium for sodium in the colonic lumen and has been used for decades to treat patients with hyperkalemia. However, possible severe gastrointestinal complications, particularly intestinal necrosis, have been reported. Researchers have examined this association in cohort studies, but findings have been inconclusive.
In a meta-analysis of six predominantly observational studies that compared SPS with control interventions in more than 26,000 patients, the prevalence of intestinal ischemia in patients treated with SPS was 0.1%, with a pooled rate of intestinal necrosis that was not significantly higher than the rate in controls (odds ratio, 1.4). Because of risk for bias and i…