Cruz Constança S, Cruz Alvaro A, Marcílio de Souza Carlos A
Curso de Pós-graduação e Extensão em Medicina Interna da Fundação para Desenvolvimento das Ciências, Fundação Instituto Osvaldo Cruz, Salvador - Bahia, Brazil.
Nephrol Dial Transplant. 2003 Sep;18(9):1814-9. doi: 10.1093/ndt/gfg295.
Recent studies have shown a fall in global mortality with minimal side effects in severe congestive heart failure (CHF) patients receiving angiotensin-converting enzyme inhibitors (ACEI) plus spironolactone (SLN). However, the risk of hyperkalaemia due to ACEI may be increased by the concomitant use of SLN.
We conducted a retrospective cohort study by examining consecutive cases of severe decompensated CHF admitted to a university hospital in Brazil from March 1999 to March 2000, which had used ACEI with or without SLN. We reviewed charts for the 30 days following admission and assessed various therapeutic regimens used for heart failure as well as serum potassium and creatinine, before and after drug exposure. The primary end-point was the development of hyperkalaemia (K > or = 5.5 mEq/l). For analysis, the subjects were split into patients treated with ACEI/SLN (n = 49) and patients treated with ACEI (n = 51) by itself.
Although demographical and clinical features were comparable between the two groups, ACEI/SLN patients had a higher proportion of class IV CHF. We found 16 cases of hyperkalaemia in ACE/SLN patients, but only one case in ACEI subjects. The odds ratio for developing hyperkalaemia in ACEI/SLN patients was 24. When class III CHF subjects were excluded, the odds ratio was 14.6 (95% confidence interval: 1.8-119.6). The best predictors of hyperkalaemia were class IV CHF, increases in creatinine following treatment and diabetes.
Patients with severe decompensated CHF using ACEI with SLN are at major risk for developing hyperkalaemia.
近期研究表明，在接受血管紧张素转换酶抑制剂（ACEI）加螺内酯（SLN）治疗的重度充血性心力衰竭（CHF）患者中，全球死亡率有所下降，且副作用极小。然而，ACEI与SLN联合使用可能会增加高钾血症的风险。
我们进行了一项回顾性队列研究，研究对象为1999年3月至2000年3月间入住巴西一家大学医院的连续重度失代偿性CHF病例，这些病例使用了ACEI，有或没有使用SLN。我们查阅了入院后30天的病历，评估了用于心力衰竭的各种治疗方案以及药物暴露前后的血清钾和肌酐水平。主要终点是高钾血症（血钾≥5.5 mEq/L）的发生情况。为进行分析，将受试者分为接受ACEI/SLN治疗的患者（n = 49）和单独接受ACEI治疗的患者（n = 51）。
尽管两组患者的人口统计学和临床特征具有可比性，但ACEI/SLN组中IV级CHF患者的比例更高。我们发现ACEI/SLN组有16例高钾血症病例，而ACEI组仅有1例。ACEI/SLN组发生高钾血症的优势比为24。排除III级CHF患者后，优势比为14.6（95%置信区间：1.8 - 119.6）。高钾血症的最佳预测因素是IV级CHF、治疗后肌酐升高和糖尿病。
使用ACEI联合SLN治疗的重度失代偿性CHF患者发生高钾血症的风险很大。
