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Published: 2024-09-30
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Histopathological lesions of the gastrointestinal tract associated with the use of polystyrene sulfonate and sevelamer: a meta-analysis

Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
Department of Medicine and Surgery, University of Parma, Parma, Italy; Nephrology Unit, University Hospital of Parma, Parma, Italy
Department of Medicine and Surgery, University of Parma, Parma, Italy; Nephrology Unit, University Hospital of Parma, Parma, Italy
Department of Neuroscience, Biophysics and Medical Physics Unit, University of Parma, Parma, Italy
Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
polystyrene sulfonate sevelamer gastrointestinal adverse events

Abstract

Background. Gastrointestinal severe adverse events such as ulceration and perforation have been reported for sodium or calcium polystyrene sulfonate and sevelamer. Howewer, their role in the pathogenesis is unclear. Chronic kidney disease is a well known risk factor, while the role of hypertension and/or diabetes is uncertain.

Methods. A meta-analysis of the published literature was conducted to review the clinical features, risk factors and histopathological findings of patients who experienced gastrointestinal adverse events after administration of polystyrene sulfonate or sevelamer.

Results. The meta-analysis indicated that patients were more likely to show necrosis and/or perforation when the resin used was polystyrene sulfonate compared to sevelamer (p < 0.001). Death was more likely in patients taking polystyrene sulfonate compared to sevelamer (p < 0.001).

Discussion. The results show that sevelamer is more likely to lead to inflammation or ulceration in the gastrointestinal tract than polystyrene sulfonate, which is more likely to be associated with severe gastrointestinal adverse events such as necrosis and/or perforation. Polystyrene sulfonate is significantly associated with death compared to sevelamer.

Affiliations

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$authorString->getFullName() => Gianluca Di Rienzo

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Gianluca Di Rienzo

Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
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$authorString->getFullName() => Pellegrino Crafa

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Pellegrino Crafa

Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
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$authorString->getFullName() => Marco Delsante

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Marco Delsante

Department of Medicine and Surgery, University of Parma, Parma, Italy; Nephrology Unit, University Hospital of Parma, Parma, Italy
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$authorString->getFullName() => Enrico Fiaccadori

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Enrico Fiaccadori

Department of Medicine and Surgery, University of Parma, Parma, Italy; Nephrology Unit, University Hospital of Parma, Parma, Italy
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$authorString->getFullName() => Giuseppe Pedrazzi

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Giuseppe Pedrazzi

Department of Neuroscience, Biophysics and Medical Physics Unit, University of Parma, Parma, Italy
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$authorString->getFullName() => Nicoletta Campanini

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Nicoletta Campanini

Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
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$authorString->getFullName() => Emilia Corradini

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Emilia Corradini

Department of Medicine and Surgery, University of Parma, Parma, Italy; Anatomic Pathology Unit, University Hospital of Parma, Parma, Italy
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Copyright

© Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology , 2024

How to Cite

[1]
Di Rienzo, G., Crafa, P., Delsante, M., Fiaccadori, E., Pedrazzi, G., Campanini, N. and Corradini, E. 2024. Histopathological lesions of the gastrointestinal tract associated with the use of polystyrene sulfonate and sevelamer: a meta-analysis. Pathologica - Journal of the Italian Society of Anatomic Pathology and Diagnostic Cytopathology. 116, 4 (Sep. 2024), 216-221. DOI:https://doi.org/10.32074/1591-951X-994.
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