Sica Domenic A, Gehr Todd W B, Yancy Clyde
Section of Clinical Pharmacology and Hypertension, Medical College of Virginia of Virginia Commonwealth University, MCBV Station Box 980160, Richmond, VA 23298-0160, USA.
Congest Heart Fail. 2003 Jul-Aug;9(4):224-9. doi: 10.1111/j.1527-5299.2003.02397.x.
Hyperkalemia is a common occurrence in patients with congestive heart failure, particularly when renal failure coexists. The level of renal function in congestive heart failure is often difficult to ascertain because good measurement tools for estimation of renal function are not available. Serum creatinine values have often been offered as a good gauge of renal function, although in most cases true renal function is appreciably lower than the estimate derived from a specific serum creatinine value. Thus, patients with congestive heart failure very commonly, particularly in the advanced stages of the disease, have moderate renal insufficiency, either due to specific heart failure-related renal perfusion changes or as the result of renal involvement from the same processes having caused the heart failure, as is the case with diabetes. It is in this setting of mild-to-moderate levels of renal failure that therapies, such as angiotensin-converting inhibitors, angiotensin-receptor blockers, and aldosterone-receptor antagonists, are administered either individually or collectively. Each of these drug classes reduces the homeostatic ability to eliminate ingested potassium loads by the renal route and increase the tendency to evolve into a hyperkalemic state. This is noteworthy because aldosterone-receptor antagonists are increasingly considered as important therapies in the long-term management of heart failure. Spironolactone has been employed in this capacity and a new aldosterone-receptor antagonist, eplerenone, will become available in the near future, which further increases the importance of evaluating and treating the hyperkalemia risk in a timely manner.
高钾血症在充血性心力衰竭患者中很常见，尤其是在合并肾衰竭时。由于缺乏评估肾功能的良好测量工具，充血性心力衰竭患者的肾功能水平往往难以确定。血清肌酐值常被用作肾功能的良好指标，尽管在大多数情况下，真正的肾功能明显低于根据特定血清肌酐值得出的估计值。因此，充血性心力衰竭患者非常常见，尤其是在疾病晚期，会出现中度肾功能不全，这要么是由于与心力衰竭相关的特定肾灌注变化，要么是由于导致心力衰竭的相同过程累及肾脏，如糖尿病患者的情况。正是在这种轻度至中度肾衰竭的情况下，诸如血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和醛固酮受体拮抗剂等治疗方法会单独或联合使用。这些药物类别中的每一种都会降低肾脏通过肾脏途径消除摄入钾负荷的稳态能力，并增加发展为高钾血症状态的倾向。这一点值得注意，因为醛固酮受体拮抗剂在心力衰竭的长期管理中越来越被视为重要的治疗方法。螺内酯已被用于此用途，一种新的醛固酮受体拮抗剂依普利酮将在不久的将来上市，这进一步增加了及时评估和治疗高钾血症风险的重要性。
