肾素-血管紧张素系统阻断剂与慢性血液透析患者的高钾血症无关。

Renin-angiotensin system blockade is not associated with hyperkalemia in chronic hemodialysis patients.

机构信息

Department of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan.

出版信息

Ren Fail. 2009;31(10):942-5. doi: 10.3109/08860220903216147.

DOI:10.3109/08860220903216147

PMID:20030530

Abstract

BACKGROUND

Serious hyperkalemia was reported in 10% of chronic hemodialysis (HD) patients that could lead to arrhythmia and death. Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) are well accepted for cardio-protective benefits. The relationship between renin-angiotensin system blockade (RASB) and hyperkalemia in chronic HD patients remains controversial. The aim of this study was to find the relationship between RASB and hyperkalemia in these patients.

METHODS

Pre-dialysis serum potassium, clinical factors, and drugs were evaluated in 200 chronic HD patients in one HD center. Hyperkalemia was defined as serum K >or= 5.3 meq/L. Finally, multivariate analysis with logistic regression was used to evaluate the risk of hyperkalemia by RASB and other factors.

RESULTS

In 200 patients, the mean K was 4.93 +/- 0.79 meq/L, and 70 (35%) patients had hyperkalemia. Fifty-eight (29%) patients were prescribed with RASB. Seven variables--non-DM, longer HD duration, lower dialysate calcium, lower serum glucose, higher serum iPTH, not using RASB, and not using furosemide--were more frequent in hyperkalemia group. In logistic regression analysis, RASB was associated with decreased odds for hyperkalemia (OR 0.262, p = 0.001 in model A; OR 0.205, p = 0.001 in model B). In addition, furosemide was associated with decreased odds for hyperkalemia (OR 0.068, p = 0.022 in model B).

CONCLUSIONS

RASB is not associated with hyperkalemia in chronic HD patients.

摘要

背景

在 10%的慢性血液透析（HD）患者中报告了严重的高钾血症，这可能导致心律失常和死亡。血管紧张素转换酶抑制剂（ACE-I）和血管紧张素 II 受体阻滞剂（ARB）因其心脏保护益处而被广泛接受。肾素-血管紧张素系统阻断（RASB）与慢性 HD 患者高钾血症之间的关系仍存在争议。本研究旨在探讨这些患者中 RASB 与高钾血症之间的关系。

方法

在一个 HD 中心的 200 例慢性 HD 患者中评估了透析前血清钾、临床因素和药物。高钾血症定义为血清 K >or= 5.3 meq/L。最后，采用多元逻辑回归分析评估 RASB 和其他因素对高钾血症的风险。

结果

在 200 例患者中，平均 K 为 4.93 +/- 0.79 meq/L，70（35%）例患者发生高钾血症。58（29%）例患者服用了 RASB。在高钾血症组中，有 7 个变量——非糖尿病、HD 时间更长、透析液钙更低、血清葡萄糖更低、血清 iPTH 更高、未使用 RASB 和未使用呋塞米——更为常见。在逻辑回归分析中，RASB 与高钾血症的几率降低相关（模型 A 中 OR 0.262，p = 0.001；模型 B 中 OR 0.205，p = 0.001）。此外，呋塞米与高钾血症的几率降低相关（模型 B 中 OR 0.068，p = 0.022）。