Ko Dennis T, Juurlink David N, Mamdani Muhammad M, You John J, Wang Julie T, Donovan Linda R, Tu Jack V
Division of Cardiology, Shulich Heart Centre, Department of Medicine, Sunnybrook and Women's Health Sciences Centre, Toronto, Ontario, Canada.
J Card Fail. 2006 Apr;12(3):205-10. doi: 10.1016/j.cardfail.2006.01.003.
The Randomized Aldactone Evaluation Study (RALES) established the safety and benefit of spironolactone for heart failure (HF) patients with systolic dysfunction. However, recent data have raised concerns regarding hyperkalemia secondary to spironolactone use and suggest it occurs more commonly in routine practice.
We explored factors potentially associated with hyperkalemia from spironolactone therapy in a population-based cohort of 9165 HF patients hospitalized in Ontario, Canada, between 1999 and 2001. Compared with patients enrolled in RALES, community-based patients were older (mean age 75 years versus 65 years, P < .001) and were more likely to be female (50% versus 27%, P < .001). Of the 1502 patients that were prescribed spironolactone at discharge, 18% had elevated serum potassium levels (>5 mmol/L) during hospitalization and 23% were discharged on concurrent potassium supplements. Although only 8% of patients had serum creatinine >2.5 mg/dL, many patients had stage III (53.1%), stage IV (12.8%), or stage V (3.9%) chronic renal insufficiency according to glomerular filtration rate.
Spironolactone was often prescribed to inappropriate HF candidates because of the presence of relative or absolute contraindications. These findings highlight the need for more careful patient selection when prescribing spironolactone to minimize potential life-threatening hyperkalemia.
随机螺内酯评估研究（RALES）证实了螺内酯对收缩功能障碍的心力衰竭（HF）患者的安全性和益处。然而，近期数据引发了对使用螺内酯继发高钾血症的担忧，并表明其在常规临床实践中更为常见。
我们在1999年至2001年间对加拿大安大略省9165例住院HF患者的人群队列中，探讨了与螺内酯治疗所致高钾血症潜在相关的因素。与RALES研究中的患者相比，社区患者年龄更大（平均年龄75岁对65岁，P <.001），且更可能为女性（50%对27%，P <.001）。在出院时开具螺内酯处方的1502例患者中，18%在住院期间血清钾水平升高（>5 mmol/L），23%出院时同时服用钾补充剂。尽管只有8%的患者血清肌酐>2.5 mg/dL，但根据肾小球滤过率，许多患者存在Ⅲ期（53.1%）､Ⅳ期（12.8%）或Ⅴ期（3.9%）慢性肾功能不全。
由于存在相对或绝对禁忌证，螺内酯常被不恰当地用于HF患者。这些发现凸显了在开具螺内酯处方时更谨慎选择患者的必要性，以尽量减少潜在的危及生命的高钾血症。
