Lima Marcelo Villaça, Ochiai Marcelo Eidi, Cardoso Juliano Novaes, Morgado Paulo César, Munhoz Robinson Tadeu, Barretto Antonio Carlos Pereira
Hospital Auxiliar de Cotoxó, São Paulo, Brasil.
Arq Bras Cardiol. 2008 Sep;91(3):177-82, 194-9. doi: 10.1590/s0066-782x2008001500009.
The incidence of hyperkalemia related to spironolactone use is low in stable heart failure; however, it has not been studied during decompensation.
To evaluate the influence of spironolactone on serum potassium in decompensated heart failure (HF).
In a cohort study, patients that had been hospitalized due to decompensated HF, with left ventricular ejection fraction (LVEF) < 0.45 and serum potassium between 3.5 and 5.5 mEq/l were selected. The patients were divided according to spironolactone use (Group S) or no use (Group C). The outcome was potassium increase (> 6.0 mEq/l) and the use of calcium polystyrene. A multivariate analysis through logistic regression was carried out and values of p < 0.05 were considered significant.
A total of 186 patients (group S: 56; group C: 130) were studied; LVEF of 0.25, aged 55.5 years and 65.2% of them males. The incidence of hyperkalemia was 10.7% in group S and 5.4% in group C (p = 0.862). The multivariate analysis showed that serum urea > 60.5 mg/dl during the hospitalization presents a relative risk of 9.6 (95%CI 8.03 - 11.20; p = 0.005) for the occurrence of hyperkalemia.
The incidence of hyperkalemia was two-fold higher with spironolactone use, but it was not statistically significant. The increase in urea levels was associated to the hyperkalemia. Randomized studies are necessary to clarify this issue.
在稳定型心力衰竭中，与使用螺内酯相关的高钾血症发生率较低；然而，在失代偿期尚未进行研究。
评估螺内酯对失代偿性心力衰竭（HF）患者血清钾的影响。
在一项队列研究中，选择因失代偿性HF住院、左心室射血分数（LVEF）<0.45且血清钾在3.5至5.5 mEq/l之间的患者。根据是否使用螺内酯将患者分为两组（S组：使用；C组：未使用）。观察指标为血钾升高（>6.0 mEq/l）和使用聚苯乙烯磺酸钙的情况。通过逻辑回归进行多变量分析，p<0.05的值被认为具有统计学意义。
共研究了186例患者（S组：56例；C组：130例）；LVEF为0.25，年龄55.5岁，其中65.2%为男性。S组高钾血症发生率为10.7%，C组为5.4%（p = 0.862）。多变量分析显示，住院期间血清尿素>60.5 mg/dl发生高钾血症的相对风险为9.6（95%CI 8.03 - 11.20；p = 0.005）。
使用螺内酯时高钾血症发生率高出两倍，但无统计学意义。尿素水平升高与高钾血症相关。需要进行随机研究以阐明这一问题。
