Table 1.
Summary of Clinicopathologic Findings of Patients with Kayexalate or Kalimate-Associated Gastrointestinal Injury in the Literature and the Present Case
| Authors | No. of Patients | Gender | Age, Mean (SD) | Type of Resin | Type of Suspension | Route of Administration | Time Interval (Day) | Presenting Symptoms | Location | Histopathologic Findings | Kayexalate Crystals or Kalimate Crystals | Associated Conditions | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ziv Harel et al | 58 | 58 ± 18 | Kayexalate (41) | Sorbitol (41) | Oral route (40) | 1.5 | Abdominal pain/tenderness (21) | Esophagus (1) | Necrosis (30) | 38 | Chronic kidney disease (10) | Alive (22) | |
| Per rectum (14) | Nausea/vomiting (2) | Stomach (2) | Ulceration (12) | ESRD requiring dialysis (19) | Death (15) | ||||||||
| Male (22) | Nasogastric (2) | GI bleed (9) | Small bowel (11) | Perforation (3) | Transplant (7) | Not reported (4) | |||||||
| Female (19) | Diarrhea (3) | Cecum (4) | Coronary artery disease (8) | ||||||||||
| Colon (33) | CVD (1) | ||||||||||||
| Sigmoid/rectum/anus (4) | Hypertension (19) | ||||||||||||
| Diabetes (8) | |||||||||||||
| 58 ± 16 | Kayexalate (17) | No sorbitol (17) | Oral route (18) | 5 | Abdominal pain/tenderness (13) | Esophagus (0) | Necrosis (7) | 14 | Chronic kidney disease (5) | Alive (11) | |||
| Per rectum (1) | Nausea/vomiting (4) | Stomach (0) | Ulceration (9) | ESRD requiring dialysis (7) | Death (4) | ||||||||
| Male (7) | Nasogastric (0) | GI bleed (5) | Small bowel (1) | Perforation (2) | Transplant (2) | Not reported (2) | |||||||
| Female (10) | Diarrhea (8) | Cecum (2) | Coronary artery disease (2) | ||||||||||
| Colon (12) | CVD (4) | ||||||||||||
| Sigmoid/rectum/anus (5) | Hypertension (5) | ||||||||||||
| Diabetes (2) | |||||||||||||
| Sung et al | 1 | Female (1) | 63 | Kayexalate | Sorbitol (1) | Oral route (1) | NA | Abdominal pain/tenderness (1) | Colon (1) | Necrosis (1) | 1 | ESRD requiring dialysis (1) | Alive (1) |
| GI bleed (1) | Ulceration (1) | ||||||||||||
| Sumanth et al | 1 | Female (1) | 59 | Kayexalate | Sorbitol (1) | Oral route (1) | NA | GI bleed (1) | Stomach (1) | Ulceration (1) | 1 | ESRD requiring dialysis (1) | Alive (1) |
| Mazen et al | 1 | Male (1) | 61 | Kayexalate (30 g/d) | Sorbitol (1) | Oral route (1) | NA | Abdominal pain/tenderness (1) | Stomach (1) | Ulceration (1) | 1 | CRF (GFR <30) (1) | Alive (1) |
| GI bleed (1) | Cecum (1) | ||||||||||||
| Colon (1) | |||||||||||||
| Gabrielle et al | 1 | Male (1) | 58 | Kayexalate | Sorbitol (1) | Per rectum (1) | 14 | Abdominal pain/tenderness (1) | Colon (1) | Ulceration (1) | 1 | ESRD requiring dialysis (1) | Alive (1) |
| GI bleed (1) | Perforation (1) | Biliary pancreatitis (1) | |||||||||||
| Respiratory failure (1) | |||||||||||||
| Massimo et al | 1 | Male (1) | 59 | Kayexalate | Sorbitol (1) | Oral route (1) | NA | GI bleed (1) | Esophagus (1) | Ulceration (1) | 1 | CRF (GFR <30) (1) | Alive (1) |
| Ana Alves et al | 1 | Female (1) | 83 | Kayexalate | No sorbitol (1) | Oral route (1) | 2 | Abdominal pain/tenderness (1) | Rectum (1) | Ulceration (1) | 1 | Alive (1) | |
| GI bleed (1) | Major depressive disorder (1) | ||||||||||||
| Diarrhea (1) | Hypertension (1) | ||||||||||||
| L. Pirona et al | 1 | Male (1) | 61 | Kayexalate (15 g/d) | Sorbitol (1) | Oral route (1) | 60 | Abdominal pain/tenderness (1) | Colon (1) | Ulceration (1) | 1 | CRF (GFR <20) (1) | Alive (1) |
| Perforation (1) | Hypertension (1) | ||||||||||||
| Nicolas et al | 1 | Male (1) | 56 | Kayexalate | No sorbitol (1) | Oral route (1) | 14 | Abdominal pain/tenderness (1) | Duodenum (1) | Hemorrhagic duodenitis (1) | ESRD and kidney transplant three weeks ago (1) | Alive (1) | |
| GI bleed (1) | Ulceration (1) | 1 | Diabetes (1) | ||||||||||
| Hypertension (1) | |||||||||||||
| Dyslipidemia (1) | |||||||||||||
| Sheba et al | 6 | Male (4) | 63 | Kayexalate (6) | Sorbitol (6) | Oral route (6), Per rectum (6) | 7 | Abdominal pain/tenderness (1) | Jejunum (1) | Ulceration (6), Perforation (1), Stricture (1) | 6 | Chronic kidney disease (5) | Alive (5) |
| Female (2) | GI bleed (6) | Colon (4), Rectum (4) | Polypoid lesion (1) Nodular lesion(1) | Kidney transplant and ESRD requiring dialysis (1) | Death (1) | ||||||||
| Chou et al | 1 | Male (1) | 30 | Kayexalate | Sorbitol (1) | Oral route (1) | 3 | GI bleed (1) | Colon (1) | Ulceration (1) | 1 | Hypertension (1) | Alive (1) |
| Per rectum (1) | ESRD requiring dialysis (1) | ||||||||||||
| Ureteral urothelial carcinoma status posttransurethral resection of bladder tumor and chemotherapy | |||||||||||||
| Kao et al | 1 | Female (1) | 59 | Kalimate (60 g/d) | No sorbitol (1) | Oral route (1) | 3 | Abdominal pain/tenderness (1) | Small bowel (1) | Ulceration (1) | 1 | Hypertension (1) | Death (1) |
| GI bleed (1) | Colon (1) | Necrosis (1) | Diabetes (1) | ||||||||||
| Perforation (1) | ESRD requiring dialysis (1) | ||||||||||||
| CAD (1), PAOD (1), COPD (1) | |||||||||||||
| Mee et al | 1 | Male (1) | 34 | Kalimate | No sorbitol (1) | Oral route (1) | 3 | GI bleed (1) | Sigmoid/Rectum (1) | Necrosis (1) | 1 | Respiratory failure (1) | Alive (1) |
| Per rectum (1) | Ulceration (1) | Hypertension (1) | |||||||||||
| María et al | 1 | Male (1) | 73 | Kalimate | No sorbitol (1) | Oral route (1) | NA | GI bleed (1) | Colon (1) | Ulceration (1) | 1 | Dyslipidemia (1) | Alive (1) |
| Coronary artery disease (1) | |||||||||||||
| Hyperuricemia (1) | |||||||||||||
| Su et al | 1 | Female (1) | 66 | Kalimate (5 g/d) | No sorbitol (1) | Oral route (1) | 120 | Abdominal pain/tenderness (1) | Colon (1) | Necrosis (1) | 1 | CRF (GFR <15) (1) | Alive (1) |
| GI bleed (1) | Sigmoid/rectum/anus (1) | Ulceration (1) | Hypertension (1) | ||||||||||
| Stenosis (1) | |||||||||||||
| Wu et al | 1 | Female (1) | 77 | Kalimate (30 g/d) | No sorbitol (1) | Oral route (1) | 14 | Abdominal pain/tenderness (1) | Esophagus (1) | Necrosis (1) | 1 | CRF (GFR <30) (1) | Alive (1) |
| GI bleed (1) | Stomach (1) | Ulceration (1) | Hypertension (1) | ||||||||||
| Duodenum (1) | |||||||||||||
| Ana et al | 1 | Female(1) | 83 | Kayexalate | No sorbitol (1) | Oral route (1) | 2 | Abdominal pain(1) | Rectum (1) | Ulceration (1) | 1 | CRF (GFR <30) (1) | Alive (1) |
| Diarrhea (1) | Hypertension (1) | ||||||||||||
| Major depressive disorder(1) | |||||||||||||
| Sagar Patel et al | 1 | Male (1) | 45 | Kayexalate | Sorbitol (1) | Oral route (1) | 4 | Abdominal pain(1) | Terminal ileum | Ulceration (1) | 1 | Acute kidney injury (1) | Alive (1) |
| Diarrhea (1) | Rectum (1) | Thymoma(1) | |||||||||||
| GI bleed (1) | Colon (1) | ||||||||||||
| Assanee Tongyoo et al | 1 | Male (1) | 52 | Kalimate | No sorbitol (1) | Oral route (1) | 5 | Abdominal pain(1) | Small bowel (1) | Obstruction (1) | 0 | Necrotizing fasciitis (1) | Death (1) |
| Bowel ileus | Stomach (1) | Above-knee amputation (1) | |||||||||||
| Colon (1) | CRF (GFR <30) (1) | ||||||||||||
| Gabrielle et al | 1 | Male (1) | 58 | Kayexalate | Sorbitol (1) | Per rectum (1) | 14 | GI bleed (1) | Colon (1) | Ulceration (1) | 1 | Severe biliary pancreatitis (1) | Alive (1) |
| Necrosis (1) | Acute kidney injury requiring dialysis (1) | ||||||||||||
| Perforation (1) | Respiratory failure (1) | ||||||||||||
| Helena Ribeiro et al | 1 | Male (1) | 72 | Kalimate | No sorbitol (1) | Oral route (1) | 3 | Abdominal pain (1) | Colon (1) | Ulceration (1) | 1 | ESRD requiring hemodialysis (1) | Alive (1) |
| Necrosis (1) | Ischemic heart disease (1) | ||||||||||||
| Arterial hypertension (1) | |||||||||||||
| Bérengère | 2 | Male (1) | 34 | Kayexalate (2) | No sorbitol (1) | Per rectum (2) | 2 | GI bleed (1) | Colon (2) | Ulceration (2) | 2 | CRF (GFR <30) (2) | Alive (2) |
| Female(1) | 64 | 3 | Rectum (2) | ||||||||||
| Alexandre | 1 | Male (1) | 54 | Kayexalate | Sorbitol (1) | Oral route (1) | 2 | GI bleed (1) | Stomach (1) | Ulceration (1) | 1 | Cardiovascular failure (1) | Alive (1) |
| Necrosis (1) | Septic shock (1) | ||||||||||||
| Daphne | 1 | Female(1) | 4 | Kayexalate | Sorbitol (1) | Per rectum (1) | 1 | GI bleed (1) | Rectum (1) | Ulcer (1) | 1 | ESRD requiring hemodialysis (1) | Alive (1) |
| Small bowel (1) (ileorectal anastomosis) | Polypoid lesion (1) | Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (1) | |||||||||||
| Colon (1) | |||||||||||||
| Kathleen | 1 | Male (1) | 60 | Kayexalate | Sorbitol (1) | Oral route (1) | 5 | Abdominal pain/tenderness (1) | Colon (1) | Ulceration (1) | 1 | HTN (1) | Alive (1) |
| GI bleed (1) | Necrosis (1) | DM (1) | |||||||||||
| Perforation (1) | CHF (1) | ||||||||||||
| RCC (1) | |||||||||||||
| CKD (1) | |||||||||||||
| Chih-Chin | 1 | Female(1) | 59 | Kalimate | No sorbitol (1) | Oral route (1) | 3 | Abdominal pain/tenderness (1) | Small bowel (1) | Ulceration (1) | 1 | ESRD (1) | Death (1) |
| GI bleed (1) | Colon (1) | Necrosis (1) | HTN (1) | ||||||||||
| Perforation (1) | DM (1) | ||||||||||||
| Philippe | 1 | Female(1) | 73 | Kalimate | No sorbitol (1) | Oral route (1) | 4 | Abdominal pain/tenderness (1) | Small bowel (1) | Ulceration (1) | 1 | Acute colonic pseudoobstruction (1) | Death (1) |
| Colon (1) | Necrosis (1) | AKI (1) | |||||||||||
| Perforation (1) | |||||||||||||
| EMMANUEL | 1 | Male (1) | 53 | Kayexalate | Sorbitol (1) | Oral route (1) | 7 | No symptoms | Esophagus (1) | Ulceration (1) | 1 | Lung transplantation for idiopathic pulmonary fibrosis (1) | Alive (1) |
| Gastroparesis (1) | Gastroparesis (1) | ||||||||||||
| S Rugolotto | 1 | Male (1) | 0.6 (27weeks of gestation) | Kayexalate | No sorbitol (1) | Per rectum (1) | 1 | GI bleed (1) | Small bowel (ileum) (1) | Ulceration (1) | 1 | Sepsis (1) | Alive (1) |
| Necrosis (1) | ESRD (1) | ||||||||||||
| Kanokrat | 1 | Female(1) | 0.8 (38 weeks gestation) | Kalimate | No sorbitol (1) | Oral route (1) | 1 | Abdominal distention (1) | Small bowel (1) | Ulceration (1) | 1 | Pulmonary atresia (1) | Alive (1) |
| GI bleed (1) | Stomach (1) | Necrosis (1) | Acute kidney injury (1) | ||||||||||
| Perforation (1) | |||||||||||||
| Wai Tat | 1 | Female(1) | 79 | Kalimate | No sorbitol (1) | Oral route (1) | 14 | Abdominal pain/tenderness (1) | Small bowel (1) | Ulceration (1) | 1 | CKD (1) | Alive (1) |
| GI bleed (1) | Colon (1) | Necrosis (1) | |||||||||||
| Perforation (1) | |||||||||||||
| Mary Bui | 1 | Female(1) | 70 | Kayexalate | No sorbitol (1) | Oral route (1) | 365 (one year) (a dose of 15 grams twice daily after meals) | Abdominal pain (1) | Stomach (1) | Inflammation | 1 | Coronary artery disease (1) | Alive (1) |
| Constipation with intermittent loose bowel movements and the stool guaiac tested positive. | Small bowel (1) | A mass | ESRD requiring hemodialysis (1) | ||||||||||
| Colon (1) (a pseudotumor on the upper lip of the ileocecal valve) | Secondary hyperparathyroidism s/p parathyroidectomy (1) | ||||||||||||
| Abdulaziz | 1 | Male (1) | 64 | Kayexalate | No sorbitol (1) | Oral route (1) | 1 | Abdominal pain (1) | Small bowel (1) | Ulceration (1) | 1 | Tongue cancer (1) | Alive (1) |
| GI bleed (1) | Colon (1) | Necrosis (1) | Septic shock (1) | ||||||||||
| AKI on CKD (1) | |||||||||||||
| Takeshi | 1 | Female(1) | 77 | Kalimate | Sorbitol (1) | Oral route (1) | 9 | Abdominal pain (1) | Colon (1) | Sigmoidovesical fistula (1) | 1 | Diabetic ketoacidosis | Alive (1) |
| GI bleed (1) | Stenosis (1) | CAD (1) | |||||||||||
| Ulcer (1) | |||||||||||||
| Kohei | 1 | Male (1) | 79 | Kalimate | Sorbitol (1) | Oral route (1) | 240 (8 months) | Abdominal pain (1) | Small bowel (1) | Ulcer (1) | 1 | DM (1) | Alive (1) |
| GI bleed (1) | Colon (1) | HTN (1) | |||||||||||
| Diarrhea (1) | CKD (1) | ||||||||||||
| CHF (1) | |||||||||||||
| Roberto | 1 | Female(1) | 80 | Kayexalate | Sorbitol (1) | Oral route (1) | 1 | Abdominal pain (1) | Colon (1) | Ulceration (1) | 1 | CKD (1) | Alive (1) |
| Diarrhea (1) | Necrosis (1) | CHF (1) | |||||||||||
| COPD (1) | |||||||||||||
| Smiley | 10 | Male (6) | 64.2 (41–82 y/o) | Kayexalate (10) | NA | NA | NA | NA | Small bowel (3) | Ulceration (7) | 10 | CKD (9) | Alive (1) |
| Female(4) | Stomach (2) | Necrosis (1) | |||||||||||
| Colon (10) | Granulation tissue (6) | ||||||||||||
| Rectum (2) | Obstruction (1) | ||||||||||||
| Hussein Nassereddine | 1 | Male (1) | 52 | Kayexalate (1) | No Sorbitol (0) | NA | NA | Kayexalate crystal (1) | - | Alive (1) | |||
| Oral route (1) | Esophagus (0) | Necrosis (0) | Chronic kidney disease (1) | ||||||||||
| Per rectum (1) | Stomach (0) | Ulceration (1) | ESRD requiring dialysis (0) | ||||||||||
| Nasogastric (0) | Small bowel (0) | Perforation (1) | Transplant (0) | ||||||||||
| Cecum (0) | Coronary artery disease (0) | ||||||||||||
| Colon (1) | CVD (0) | ||||||||||||
| Rectum/anus (1) | Hypertension (0) | ||||||||||||
| Diabetes (0) | |||||||||||||
| Robert Hunt Dunlap | 1 | Female (1) | 55 | Kayexalate (1) | No Sorbitol (0) | NA | 3 | Kayexalate crystal (1) | - | Alive (1) | |||
| Abdominal pain/tenderness (0) | Esophagus (0) | Necrosis (1) | Chronic kidney disease (1) | ||||||||||
| Nausea/vomiting (0) | Stomach (0) | Ulceration (1) | ESRD requiring dialysis (1) | ||||||||||
| GI bleed (1) | Small bowel (1) | Perforation (1) | Transplant (0) | ||||||||||
| Diarrhea (1) | Cecum (1) | Coronary artery disease (0) | |||||||||||
| Colon (1) | CVD (0) | ||||||||||||
| Rectum/anus (0) | Hypertension (1) | ||||||||||||
| Diabetes (0) | |||||||||||||
| Keigo Murakami1 | 23 | Male (2) | 69.5 | Kayexalate (4) | Sorbitol (4) | Oral route (3), Per rectum (1) | 24.8 | Abdominal pain/tenderness (22) | Esophagus (0) | Necrosis (4) | Kayexalate crystal (4) | Chronic kidney disease (0) | Alive (2) |
| Nausea/vomiting (0) | Stomach (0) | Ulceration (4) | ESRD requiring dialysis (4) | Death (2) | |||||||||
| Female (2) | GI bleed (22) | Small bowel (0) | Perforation (4) | Transplant (0) | |||||||||
| Diarrhea (1) | Cecum (0) | Coronary artery disease (0) | |||||||||||
| Colon (3) | CVD (0) | ||||||||||||
| Rectum/anus (1) | Hypertension (0) | ||||||||||||
| Diabetes (1) | |||||||||||||
| Male (12) | 76.2 | Kalimate (19) | Sorbitol (19) | Oral route (3), Per rectum (16) | 156 | Abdominal pain/tenderness (22) | Esophagus (0) | Necrosis (19) | Kalimate crystal (19) | Chronic kidney disease (4) | Alive (15) | ||
| Nausea/vomiting (0) | Stomach (0) | Ulceration (19) | ESRD requiring dialysis (15) | Death (4) | |||||||||
| Female (7) | GI bleed (22) | Small bowel (0) | Perforation (19) | Transplant (0) | |||||||||
| Diarrhea (1) | Cecum (0) | Coronary artery disease (0) | |||||||||||
| Colon (18) | CVD (0) | ||||||||||||
| Rectum/anus (1) | Hypertension (0) | ||||||||||||
| Diabetes (7) | |||||||||||||
| Hussein Nassereddine | 1 | Male (1) | 89 | Kayexalate (1) | No Sorbitol (0) | NA | NA | Kayexalate crystal (1) | - | Alive (1) | |||
| Oral route (1) | Esophagus (0) | Necrosis (0) | Chronic kidney disease (1) | ||||||||||
| Per rectum (1) | Stomach (0) | Ulceration (1) | ESRD requiring dialysis (0) | ||||||||||
| Nasogastric (0) | Small bowel (0) | Perforation (1) | Transplant (0) | ||||||||||
| Cecum (0) | Coronary artery disease (0) | ||||||||||||
| Colon (1) | CVD (0) | ||||||||||||
| Rectum/anus (0) | Hypertension (0) | ||||||||||||
| Diabetes (1) |