接受抗高血压治疗的非糖尿病慢性肾病患者发生高钾血症的风险。
Risk of hyperkalemia in nondiabetic patients with chronic kidney disease receiving antihypertensive therapy.
作者信息
Weinberg Joy M, Appel Lawrence J, Bakris George, Gassman Jennifer J, Greene Tom, Kendrick Cynthia A, Wang Xuelei, Lash James, Lewis Julia A, Pogue Velvie, Thornley-Brown Denyse, Phillips Robert A
机构信息
Nephrology Division, Lenox Hill Hospital, New York, New York, USA.
出版信息
Arch Intern Med. 2009 Sep 28;169(17):1587-94. doi: 10.1001/archinternmed.2009.284.
BACKGROUND
The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database.
METHODS
A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m(2)) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, beta-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point.
RESULTS
A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center-initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/1.73 m(2), after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m(2) and a GFR lower than 30 mL/min/1.73 m(2) was 3.61 (95% confidence interval [CI], 1.42-9.18 [P = .007]) and 6.81 (95% CI, 2.67-17.35 [P < .001]), respectively; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m(2). Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95% CI, 2.29-21.39 [P < .001]) and BB group (HR, 2.85; 95% CI, 1.50-5.42 [P = .001]). Diuretic use was associated with a 59% decreased risk of hyperkalemia.
CONCLUSIONS
In nondiabetic patients with hypertensive CKD treated with ACEIs, the risk of hyperkalemia is small, particularly if baseline and follow-up GFR is higher than 40 mL/min/1.73 m(2). Including a diuretic in the regimen may markedly reduce risk of hyperkalemia.
背景
利用非裔美国人肾脏疾病与高血压研究（AASK）数据库，调查了接受血管紧张素转换酶抑制剂（ACEI）及其他抗高血压药物治疗的慢性肾脏病（CKD）患者高钾血症的发生率及相关因素。
方法
在AASK试验中，对1094例非糖尿病成年高血压CKD患者（肾小球滤过率[GFR]为20 - 65 mL/min/1.73 m²）进行了3.0至6.4年的随访。参与者被随机分配至ACEI组、β受体阻滞剂（BB）组或二氢吡啶类钙通道阻滞剂（CCB）组。该分析的结局变量为血清钾水平高于5.5 mEq/L（换算为毫摩尔每升时，乘以1.0），或临床中心启动的高钾血症停止点。
结果
共获得6497次血钾测量值，确定了51例患者中的80起事件（76起事件由中心实验室结果驱动，4起由临床中心启动的高钾血症停止点驱动）。与GFR高于50 mL/min/1.73 m²相比，多变量调整后，GFR在31至40 mL/min/1.73 m²和低于30 mL/min/1.73 m²的患者发生高钾血症的风险比（HR）分别为3.61（95%置信区间[CI]，1.42 - 9.18 [P = .007]）和6.
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