胰岛素和盐皮质激素对慢性血液透析患者肾外钾代谢的影响。

Vlassopoulos D, Sonikian M, Dardioti V, Pani I, Hadjilouka-Mantaka A, Hadjiconstantinou V

Nephrology Dept, A. Fleming Hospital, Athens, Greece.

Ren Fail. 2001 Nov;23(6):833-42. doi: 10.1081/jdi-100108195.

Insulin-mineral corticoids effects on extrarenal K+ metabolism in dialysis patients. During the inter-dialytic interval in dialyzed patients, hydrogen and potassium ions are regulated by extrarenal mechanisms. We studied the hormonal and acidotic effects on the extrarenal potassium metabolism, in selected, anuric and stable, hemodialysis patients. Fifteen patients, were grouped according to the mean mid-week pre-dialysis K+ over the past 12 months: > 6.0 mEq/L (G1, n=5), = 5.1-6.0 mEq/L (G2, n=5), < or = 5.0 mEq/L (G3, n=5). After a mid-week hemodialysis session and 12 h fasting, they received 1 g/Kg glucose p.os (A). Insulin, aldosterone, renin, pH, HCO3-, glucose, body weight, blood pressure and heart rate were measured before and 60' after the meal. We recorded the same parameters, except insulin, in 15 patients, similarly grouped, before hemodialysis (T0) and on 3 consecutive off dialysis days (T1-T3); G1 received fluorohydrocortisone (FHC) 0.1 mg-0.3 mg/day, according to body weight and G3 spironolactone (SLT) 200 mg per day. G2 were controls (B). (A) A significant rise in glycemia (81 +/- 23 to 157 +/- 52 mg/dL, P<0.001) and insulin (11.8 +/- 6.2 to 46.8 +/- 19.5 microU/mL, P<0.001), with a drop in K+ (5.1 +/- 0.6 to 4.8 +/- 0.7 mEq/L, P=0.001) and aldosterone (453 +/- 373 to 383 +/- 364 pg/mL, P<0.01), were noted at T60 vs. T0, in all groups. Insulin levels correlated negatively (r=-0.54, P<0.04) to serum K+ at T60, in all patients. (B) No major pH, HCO3 and aldosterone changes were observed in the 3 groups. Despite that, K+ dropped in G1 by FHC (6.7 +/- 0.9 to 5.9 +/- 0.6 mEq/L, P<0.05), rose in G3 by SLT (4.4 +/- 0.4 to 5.4 +/- 0.3 mEq/L, P<0.05) and remained unchanged in controls (5.8 +/- 0.2 to 5.8 +/- 0.6 mEq/L), (T0 vs T3 pre-dialysis values). Glucose significantly lowered K+ by promoting adequate insulin secretion. Drugs affecting aldosterone action significantly influenced potassium metabolism. Acid-base balance was not important in K+ handling in steady state anuric dialysis patients.

胰岛素-盐皮质激素对透析患者肾外钾代谢的影响。在透析患者的透析间期，氢离子和钾离子由肾外机制调节。我们研究了激素和酸中毒对选定的无尿且病情稳定的血液透析患者肾外钾代谢的影响。15名患者根据过去12个月中周中透析前钾离子的平均值进行分组：>6.0 mEq/L（G1组，n = 5），=5.1 - 6.0 mEq/L（G2组，n = 5），≤5.0 mEq/L（G3组，n = 5）。在周中进行血液透析治疗并禁食12小时后，他们口服1g/Kg葡萄糖（A）。在进食前和进食后60分钟测量胰岛素、醛固酮、肾素、pH值、HCO₃⁻、葡萄糖、体重、血压和心率。我们在15名患者中记录了除胰岛素外的相同参数，这些患者分组情况相似，在血液透析前（T0）以及连续3个非透析日（T1 - T3）进行记录；G1组根据体重每天接受0.1mg - 0.3mg氟氢可的松（FHC），G3组每天接受200mg螺内酯（SLT）。G2组为对照组（B）。（A）在所有组中，与T0相比，T60时血糖显著升高（从81±23至157±52mg/dL，P<0.001）和胰岛素升高（从11.8±6.2至46.8±19.5μU/mL，P<0.001），同时钾离子下降（从5.1±0.6至4.8±0.7 mEq/L，P = 0.001）和醛固酮下降（从453±373至383±364 pg/mL，P<0.01）。在所有患者中，T60时胰岛素水平与血清钾离子呈负相关（r = -0.54，P<0.04）。（B）3组中未观察到pH值、HCO₃⁻和醛固酮的重大变化。尽管如此，G1组使用FHC后钾离子下降（从6.7±0.9至5.9±0.6 mEq/L，P<0.05），G3组使用SLT后钾离子升高（从4.4±0.4至5.4±0.3 mEq/L，P<0.05），对照组则保持不变（从5.8±0.2至5.8±0.6 mEq/L）（T0与T3透析前值）。葡萄糖通过促进足够的胰岛素分泌显著降低钾离子水平。影响醛固酮作用的药物显著影响钾代谢。在稳定的无尿透析患者中，酸碱平衡在钾离子处理中并不重要。