Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
Int J Cardiol. 2010 Jan 21;138(2):174-81. doi: 10.1016/j.ijcard.2008.08.011. Epub 2008 Sep 19.
Renin-angiotensin-aldosterone system (RAAS) inhibitors are currently indispensable for the treatment of heart failure. It is well known that hyperkalemia is likely to occur in renal failure; however, it has not yet been clarified how the serum potassium concentration changes as heart failure progresses. Currently, the cardio-renal decompensation syndrome holds that the serum potassium concentration is altered similarly by both heart failure and renal failure; however, there are no definitive reports on this. In order to use RAAS inhibitors more safely and effectively in heart failure, it is necessary to understand the factors affecting serum potassium concentration in the clinical setting.
We examined the clinical factors affecting serum potassium concentration in 1035 consecutive patients with cardiovascular disease who were hospitalized in our institution. Multiple regression analysis showed that the independent factors associated with an elevated serum potassium concentration were renal insufficiency evaluated by estimated glomerular filtration rate (eGFR) (P<0.0001), diabetes mellitus evaluated by HbA(1c) (P=0.0005) and the use of RAAS inhibitors (P=0.0010). The independent factors associated with a decreased serum potassium concentration were mean blood pressure (P<0.0001), heart failure evaluated by log BNP (P=0.0164) and the use of diuretics (P=0.0232).
The serum potassium concentration decreases with the severity of heart failure if renal function is preserved. From the perspective of potassium homeostasis, we could use the RAAS inhibitors more aggressively in patients with heart failure who do not have renal failure.
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂目前是心力衰竭治疗不可或缺的。众所周知，肾功能衰竭时很可能发生高钾血症；然而，心力衰竭进展时血清钾浓度如何变化尚未阐明。目前，心肾失代偿综合征认为心力衰竭和肾功能衰竭同样改变血清钾浓度；然而，关于这方面并没有明确的报告。为了在心力衰竭中更安全有效地使用 RAAS 抑制剂，有必要了解影响临床血清钾浓度的因素。
我们检查了在我院住院的 1035 例连续心血管疾病患者中影响血清钾浓度的临床因素。多元回归分析显示，与血清钾浓度升高相关的独立因素是肾小球滤过率（eGFR）评估的肾功能不全（P<0.0001）、HbA（1c）评估的糖尿病（P=0.0005）和 RAAS 抑制剂的使用（P=0.0010）。与血清钾浓度降低相关的独立因素是平均血压（P<0.0001）、log BNP 评估的心力衰竭（P=0.0164）和利尿剂的使用（P=0.0232）。
如果肾功能正常，心力衰竭的严重程度与血清钾浓度降低相关。从钾离子动态平衡的角度来看，我们可以在没有肾功能衰竭的心力衰竭患者中更积极地使用 RAAS 抑制剂。
