Vereijken T L J, Bellersen L, Groenewoud J M M, Knubben L, Baltussen L, Kramers C
Department of Pharmacology-Toxicology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Neth J Med. 2007 Jun;65(6):208-11.
We aimed to develop a model to estimate the risk of hyperkalaemia in patients treated for heart failure in a tertiary reference hospital and to identify precipitating factors.
125 congestive heart failure (CHF) patients were studied retrospectively. Thirty of these patients developed episodes of hyperkalaemia (K>or=5.5 mmol/l). Both groups were compared for possible risk factors for hyperkalaemia (age, glomerular filtration rate (GFR), New York Heart Association (NYHA) class, diabetes mellitus (DM), ejection fraction and medication use (ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists).
On multivariate logistic regression analysis DM (OR 2.9, 95% CI=1.05 to 8.3, p=0.041), GFR<45 ml/min (OR 4.1, 95% CI=1.6 to 10.5. p=0.004) and NYHA class III-IV (OR 2.4, 95% CI=0.9 to 6.3, p=0.086) were independently associated with hyperkalaemia, whereas age, ejection fraction and medication sort and dose were not. Of the episodes of hyperkalaemia, 38% were precipitated by periods of dehydration (diarrhoea, fever) or change of medication.
We identified kidney function, diabetes mellitus and heart failure class as independent risk factors of hyperkalaemia. The majority of the hyperkalaemic episodes develop without a precipitating factor. This implies that heart failure patients in a tertiary reference hospital should be very closely monitored to minimize the risk for hyperkalaemia.
我们旨在建立一个模型，以估计在一家三级转诊医院接受心力衰竭治疗的患者发生高钾血症的风险，并确定诱发因素。
对125例充血性心力衰竭（CHF）患者进行回顾性研究。其中30例患者发生高钾血症（血钾≥5.5 mmol/L）。比较两组患者高钾血症的可能危险因素（年龄、肾小球滤过率（GFR）、纽约心脏协会（NYHA）分级、糖尿病（DM）、射血分数和药物使用情况（血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、醛固酮拮抗剂））。
多因素逻辑回归分析显示，糖尿病（比值比[OR]2.9，95%置信区间[CI]=1.05至8.3，P=0.041）、肾小球滤过率<45 ml/min（OR 4.1，95%CI=1.6至10.5，P=0.004）和NYHA III-IV级（OR 2.4，95%CI=0.9至6.3，P=0.086）与高钾血症独立相关，而年龄、射血分数以及药物种类和剂量则无关。在高钾血症发作中，38%是由脱水期（腹泻、发热）或药物变化诱发的。
我们确定肾功能、糖尿病和心力衰竭分级为高钾血症的独立危险因素。大多数高钾血症发作并无诱发因素。这意味着三级转诊医院的心力衰竭患者应受到密切监测，以将高钾血症风险降至最低。
