Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.
Am J Cardiol. 2012 May 15;109(10):1510-3. doi: 10.1016/j.amjcard.2012.01.367. Epub 2012 Feb 18.
Predictors of hyperkalemia in patients with cardiovascular disease (CVD; defined as patients with hypertension and heart failure) and associated chronic kidney disease (CKD) are not well established. The aim of this study was to ascertain risk factors of hyperkalemia (defined as serum potassium concentration >5.0 mEq/L) and associated all-cause mortality in patients with CVD treated with antihypertensive drugs that impair potassium homeostasis. In a retrospective analysis using a logistic regression model, risk factors for hyperkalemia and all-cause mortality were analyzed in 15,803 patients with CVD treated with antihypertensive drugs. The mean estimated glomerular filtration rate and mean serum potassium concentration were 55.55 ml/min/1.73 m(2) and 4.06 mEq/L, respectively. Hyperkalemia was observed in 24.5% of study patients and 1.7% of total hospital admissions. Compared to patients with normokalemia, those with hyperkalemia had a higher percentage of death (6.25% vs 2.92%, p = 0.0001) and admissions (7.80% vs 5.04%, p = 0.0001). Predictors of hyperkalemia were CKD stage (odds ratio [OR] 2.14, 95% confidence interval [CI] 2.02 to 2.28), diabetes mellitus (OR 1.59, 95% CI 1.47 to 1.72), coronary artery disease (OR 1.32, 95% CI 1.21 to 1.43), and peripheral vascular disease (OR 1.55, 95% CI 1.36 to 1.77). Predictors of all-cause mortality were CKD stage (OR 1.26, 95% CI 1.12 to 1.43), hyperkalemic event (OR 1.56, 95% CI 1.30 to 1.88), age (OR 1.04, 95% CI 1.03 to 1.05), and hospitalization (OR 1.04, 95% CI 1.04 to 1.05). In conclusion, hyperkalemia is encountered frequently in patients with established CVD who are taking antihypertensive drugs and is associated with increases in all-cause mortality and hospitalizations. Advanced CKD, diabetes mellitus, coronary artery disease, and peripheral vascular disease are independent predictors of hyperkalemia.
心血管疾病（CVD；定义为高血压和心力衰竭患者）合并相关慢性肾脏病（CKD）患者高钾血症的预测因素尚不清楚。本研究旨在确定接受影响钾稳态的降压药物治疗的 CVD 患者高钾血症（定义为血清钾浓度>5.0mEq/L）和全因死亡率的危险因素。在使用逻辑回归模型的回顾性分析中，对 15803 例接受降压药物治疗的 CVD 患者的高钾血症和全因死亡率的危险因素进行了分析。估计的肾小球滤过率和平均血清钾浓度分别为 55.55ml/min/1.73m2和 4.06mEq/L。研究患者中观察到 24.5%的患者发生高钾血症，总住院人数中有 1.7%的患者发生高钾血症。与血钾正常的患者相比，高钾血症患者的死亡率（6.25%比 2.92%，p=0.0001）和住院率（7.80%比 5.04%，p=0.0001）更高。高钾血症的预测因素包括 CKD 分期（比值比[OR]2.14，95%置信区间[CI]2.02 至 2.28）、糖尿病（OR 1.59，95%CI 1.47 至 1.72）、冠状动脉疾病（OR 1.32，95%CI 1.21 至 1.43）和外周血管疾病（OR 1.55，95%CI 1.36 至 1.77）。全因死亡率的预测因素包括 CKD 分期（OR 1.26，95%CI 1.12 至 1.43）、高钾血症事件（OR 1.56，95%CI 1.30 至 1.88）、年龄（OR 1.04，95%CI 1.03 至 1.05）和住院（OR 1.04，95%CI 1.04 至 1.05）。总之，接受降压药物治疗的已确诊 CVD 患者经常出现高钾血症，且与全因死亡率和住院率升高有关。晚期 CKD、糖尿病、冠状动脉疾病和外周血管疾病是高钾血症的独立预测因素。
