Knoll Greg A, Sahgal Arjun, Nair Rama C, Graham Janet, van Walraven Carl, Burns Kevin D
Division of Nephrology, Department of Medicine, Kidney Research Centre, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Am J Med. 2002 Feb 1;112(2):110-4. doi: 10.1016/s0002-9343(01)01068-3.
Blockade of the renin-angiotensin system by angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers can cause hyperkalemia in patients with chronic renal insufficiency who are not on dialysis, but the risk of hyperkalemia in hemodialysis patients is unknown.
We conducted a prospective study of 251 adult hemodialysis patients to determine if renin-angiotensin system blockade was associated with hyperkalemia, defined as a predialysis serum potassium concentration of 5.5 mmol/L or higher. Medication use was determined by chart review and patient interview. Predialysis serum potassium concentration was measured monthly.
There were 367 episodes of hyperkalemia during 1877 person-months of follow-up. After adjustment for potential confounding variables and for clustering of episodes by patient, use of an ACE inhibitor or an angiotensin receptor blocker was associated with a significantly higher risk of hyperkalemia (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.4 to 3.4). The increased risk of hyperkalemia with renin-angiotensin system blockade was seen in anuric dialysis patients (OR = 2.3; 95% CI: 1.3 to 4.2), as well as those with residual renal function (OR = 2.1; 95% CI: 1.0 to 4.1).
The use of ACE inhibitors or angiotensin receptor blockers is independently associated with an increased risk of developing hyperkalemia in chronic hemodialysis patients. The serum potassium concentration should be closely monitored when these medications are prescribed for hemodialysis patients.
血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂阻断肾素-血管紧张素系统可导致未接受透析的慢性肾功能不全患者发生高钾血症，但血液透析患者发生高钾血症的风险尚不清楚。
我们对251例成年血液透析患者进行了一项前瞻性研究，以确定肾素-血管紧张素系统阻断是否与高钾血症相关，高钾血症定义为透析前血清钾浓度为5.5 mmol/L或更高。通过查阅病历和患者访谈确定用药情况。每月测量透析前血清钾浓度。
在1877人月的随访期间共发生367次高钾血症发作。在对潜在混杂变量以及按患者聚类的发作情况进行校正后，使用ACE抑制剂或血管紧张素受体阻滞剂与高钾血症风险显著升高相关（比值比[OR]=2.2；95%置信区间[CI]：1.4至3.4）。在无尿透析患者（OR=2.3；95%CI：1.3至4.2）以及有残余肾功能的患者（OR=2.1；95%CI：1.0至4.1）中均观察到肾素-血管紧张素系统阻断使高钾血症风险增加。
使用ACE抑制剂或血管紧张素受体阻滞剂与慢性血液透析患者发生高钾血症的风险增加独立相关。为血液透析患者开具这些药物时应密切监测血清钾浓度。
