12 Reasons To Avoid Potassium-Binders

Nicole has been receiving pressure from her dialysis clinic to take Kayexalate (sodium polystyrene). Based on what I’ve read in Ullmann’s Encyclopedia of Industrial Chemicals, Kayexalate is much like mixing plastic and salt together. Dialysis clinics have been using it for over 50 years.

Why would you suggest someone with little kidney function consume plastic? Common sense would tell you that no one should eat plastic, no less someone on life support therapy.

Well, the reason is that Kayexalate helps lower potassium levels in the blood.  Since the kidneys aren’t working, the level of potassium rises in the bloodstream between dialysis treatments. Potassium levels above 6.5 mmol/L (known as hyperkalemia) can cause sudden and unexpected heart failure according to The Renal Association.

If all Kayexalate did was bind up potassium, we’d be all for it.  Unfortunately, its destructive effect on the colon causes death to one out of three people. I don’t know about you, but I’d rather die quickly from a heart attack than bleed to death slowly out of my bum.

Below is a copy of the two-page letter we wrote and submitted to Nicole’s dialysis clinic and nephrologist. It gives 12 reasons why we decided not to use Kayexalate. It includes references to studies from mainstream medical journals. The lack of efficacy and number of side effects is very shocking – especially considering how liberally it is handed out to dialsyis patients around the world.

Anyone is welcome to use the following letter. You can submit it to your doctor or clinic if they are pressuring you to use a potassium binder.

Date: Tuesday, May 13, 2014
Re: Kayexalate (Sodium Polystyrene) Prescription

To Whom It May Concern:

We have reviewed the literature on the use of sodium polystyrene as a potassium binder. Nicole has decided to not use the prescribed Katexalate. The effectiveness of the drug to reduce mortality has not been proven. Any benefit appears small and easily outweighed by the risks and adverse effects.

Below we provide a brief summary of our findings and hope you will appreciate our view on the matter:

1. According to the American Journal of Nephrology there has only been one large-scale study conducted on dialysis patients to determine the effectiveness of potassium-binders (despite the fact they have been prescribed for over 50 years).

2. This study involved 11,409 dialysis patients over 43 months from Canada and Europe. The study concluded that sodium-based potassium binders “had no clear association with mortality.” (American Journal of Nephrology Vol. 39, No. 3, 2014)

3. The same study showed that any reduction in hyperkaleamia was countered by increased phosphatemia, sodium retention and greater interdialytic weight gain. (American Journal of Nephrology Vol. 39, No. 3, 2014)

4. A January 2013 review of sodium polystyrene sulfonate by the US National Institute of Health concluded that it caused gastrointestinal injury in 75% of cases. 43% of those injuries proved fatal. (American Journal of Medicine, March 2013)

5. Kayexalate is derived from polystyrene, a petrochemical used to manufacture most plastics. We don’t remember seeing plastic on the food pyramid.

6. The U.S. National Institute of Health states that sodium polystyrene sulfonate is contraindicated for patients with reduced gut motility, constipation and inflammatory bowel disease. Nicole suffers from gastroparesis, reduced peristalsis, inflammatory bowel disease and intermittent constipation (which requires the use of enemas). Further impairing her gastrointestinal tract would seem to only worsen overall toxicity in her body.

7. Sodium polystyrene sulfonate can also bind magnesium and calcium, two minerals Nicole already has difficulty absorbing. An inappropriate magnesium/calcium ratio would also put her at further risk for arrhythmia.

8. The risk of digoxin toxicity.

9. Kayexlate causes an increase in serum sodium levels and is contraindicated for patients like Nicole who already suffer from edema and hypertension.

10. The drug can cause hypermagnesemia, hypercalcemia — two conditions Nicole already suffers from.

11. Certain research suggests that the optimal range for serum potassium levels for dialysis patients may be in the 5.1 – 6.4 mmol/L range. For unknown reasons, slightly higher potassium levels may be a protection against toxins building up in the blood between treatments. At the very least, the scientific consensus seems to be that heart failure is unlikely below 6.5 mmol/L.

12. The drug also causes vomiting and nausea; conditions Nicole is prone to suffering.

Nicole acknowledges the recommendation of her doctors to take Kayexalate. They will not be held liable in any way if she suffers heart failure as a result of hyperkalemia.

She reserves the right to make her own educated choices about which treatments she will receive or not receive. If you can provide scientific literature to counter the points made above, we are willing to review and possibly reconsider our decision. Otherwise, we kindly request that no further prescriptions or pressure be made by doctors or staff for her to use Kayexalate or similar potassium binders.

We do appreciate the emphasis doctors and staff have put on avoiding hyperkalemia. We will continue to make dietary modifications to keep the serum potassium level below 6.5 mmol/L. In addition, we have begun experimenting with complimentary methods to increase the elimination of potassium via perspiration and the intestines.

We thank you for your concern and all the care and attention Nicole receives at the dialysis clinic. Considering the risks associated with Kayexalate and the limited number of proven benefits, I’m sure you will respect our decision to forgo use of this drug.


Nicole Davidson-Manley

John C. A. Manley

Nicole submitted this letter a week ago. Since that time they have not pressured her to take Kayexalate. It would be nice if they admitted the drug is a poison. But that’s a bigger battle for another day.


About the Author: John C. A. Manley researches and writes about alternative treatments for type-1 diabetes and its many complications. His wife, Nicole, of 15 years has had type-1 diabetes for four decades. Together they have lowered her HgbA1c below 5.5%, regained thyroid function, increased kidney function and reversed gastroparesis. Read more about their journey out of the T1D matrix or subscribe to their Diabetic Dharma blog..