Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 18, 2023; 11(7): 351-367
Published online Dec 18, 2023. doi: 10.13105/wjma.v11.i7.351
Comprehensive analysis of sodium polystyrene sulfonate-induced colitis: A systematic review
Gabriel Peixoto Aver, Guilherme Ferreira Ribeiro, Vinícius Remus Ballotin, Francisco Souza dos Santos, Lucas Goldmann Bigarella, Floriano Riva, Eduardo Brambilla, Jonathan Soldera
Gabriel Peixoto Aver, Guilherme Ferreira Ribeiro, Vinícius Remus Ballotin, Francisco Souza dos Santos, Lucas Goldmann Bigarella, School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
Floriano Riva, Department of Pathology, CPM Laboratório de Patologia, Caxias do Sul 95084-900, RS, Brazil
Eduardo Brambilla, Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
Jonathan Soldera, Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: All authors contributed to study concept and design, and drafting of the manuscript; all authors contributed to acquisition of data, analysis, and interpretation of data; Ballotin VR contributed to statistical analysis; Brambilla E and Soldera J contributed to study supervision; all authors contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: All the authors have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, Tutor, Acute Medicine and Gastroenterology, University of South Wales, University of South Wales, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Received: September 8, 2023
Peer-review started: September 10, 2023
First decision: September 29, 2023
Revised: October 4, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: December 18, 2023
Processing time: 97 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background

The study details the significance of Sodium Polystyrene Sulfonate (SPS) in managing hyperkalemia, a life-threatening condition. SPS, used to remove excess potassium, has side effects, including severe gastrointestinal complications. The exact mechanism of SPS-induced colitis is unclear, but it primarily affects the colon, requiring biopsy for diagnosis.

Research motivation

Comprehensive understanding of the SPS therapy and colitis relationship is crucial for patient safety. This research addresses knowledge gaps, aiming to contribute to future studies in drug safety and gastroenterology.

Research objectives

This study's main goal is to systematically review cases of SPS-induced colitis to understand its prognosis and influencing factors. Achieving these objectives enhances awareness of risks tied to SPS therapy, aiding clinical decisions for hyperkalemia management and guiding future research on risk mitigation.

Research methods

This systematic review followed the PRISMA guidelines for transparency and methodological rigor. A comprehensive search strategy covered multiple databases and utilized manual searches. Inclusion criteria prioritized case reports or case series studies, with language inclusion restricted to English, Spanish, French, or Portuguese. A two-step screening process and data extraction by independent reviewers ensured rigorous analysis. Methodological quality assessment employed a modified tool, addressing specific aspects related to polystyrene-induced colitis. Data were analyzed using descriptive statistics, providing a comprehensive dataset characterization.

Research results

The review examined 442 references, including 51 which comprised 59 cases meeting the criteria. The majority of cases were from the United States (48.2%). The patients age varied from less than 1 year to 89 years and were predominantly diagnosed with SPS-induced colitis. Common symptoms included abdominal pain, bloating, and gastrointestinal issues, with chronic kidney disease being prevalent. Diagnostic procedures such as colonoscopy and biopsies were frequently conducted. Surgical intervention was necessary for 50% of patients, and most had favorable outcomes, with a mean time to symptom resolution of 36.7 days.

Research conclusions

This systematic review underscores the importance of monitoring adverse events related to SPS in hyperkalemia treatment. It differentiates mild from severe side effects, advocating for alternative hyperkalemia management, especially for older or fragile patients due to higher associated mortality. The exact mechanisms remain unclear, but factors such as renin concentration and water affinity are implicated.

Research perspectives

Future research should prioritize randomized controlled trials to assess SPS use, considering its effectiveness and risks. Alternative hyperkalemia management methods and cautious SPS prescription are crucial, with a focus on addressing knowledge gaps for informed clinical decisions.