Department of Clinical Pharmacy, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV, Zaandam, The Netherlands,
Int J Clin Pharm. 2013 Dec;35(6):1099-104. doi: 10.1007/s11096-013-9830-8. Epub 2013 Aug 22.
Hyperkalemia is a potentially dangerous electrolyte abnormality with a reported incidence of 1-10 % in hospitals. Patients are especially at risk of developing this complication if they use a combination of potassium supplements and potassium sparing diuretics or renin-angiotensin-aldosterone-system (RAAS) inhibitors. Previous studies on the occurrence of hyperkalemia in patients who use multiple potassium influencing drugs simultaneously were either small in sample size or did not investigate the full range of drugs involved.
To assess the prevalence of hyperkalemia and to identify risk factors for its development in hospitalised patients using potassium supplements, potassium-sparing diuretics and/or RAAS-inhibitors concurrently.
The study was conducted at the Onze Lieve Vrouwe Hospital in Amsterdam, The Netherlands from January 2009 to May 2010.
A retrospective, nested case-control study included hospitalised patients who used a combination of potassium-influencing drugs. Cases were patients with serum potassium ≥ 5.5 mmol/l, controls were patients with normal serum potassium levels. Cases and controls were included in a ratio of 1:2. The following known risk factors associated with hyperkalemia were recorded and statistically analyzed: diabetes mellitus, congestive heart failure, decreased renal function, advanced age, gender and use of heparin, digoxin, non-steroidal anti-inflammatory drugs, beta-blockers, calcineurin antagonists and trimethoprim.
Identify risk factors for the development of hyperkalemia as a result of the concurrent use of potassium supplements, RAAS inhibitors and/or potassium-sparing diuretics.
Of 774 patients included in this study, 52 patients developed hyperkalemia; a prevalence of 6.7 %. The only risk factor found to be significantly associated with hyperkalemia was lowered renal function, expressed as estimated glomerular filtration rate (eGFR) <50 ml/min (adjusted OR 5.08; 95 % CI 2.46-10.48). None of the other tested risk factors was identified as significant.
This study showed that decreased renal function (eGFR <50 ml/min) was associated with a fivefold increased risk for hyperkalemia in patients using potassium-influencing drugs. While previous studies showed that hyperkalemia substantially increases below a threshold of eGFR <30 or 40 ml/min, we observed a lower threshold of eGFR <50 ml/min. It is therefore recommended that physicians should be particularly alert while monitoring the use of potassium-influencing drugs in patients with decreased renal function.
高钾血症是一种潜在的危险电解质异常，其在医院的发病率为 1-10%。如果患者同时使用钾补充剂、保钾利尿剂或肾素-血管紧张素-醛固酮系统（RAAS）抑制剂，尤其有发生这种并发症的风险。之前的研究要么样本量小，要么没有调查涉及的所有药物，因此关于同时使用多种影响钾的药物的患者发生高钾血症的发生率的研究较少。
评估同时使用钾补充剂、保钾利尿剂和/或 RAAS 抑制剂的住院患者中高钾血症的发生率，并确定其发生的危险因素。
该研究于 2009 年 1 月至 2010 年 5 月在荷兰阿姆斯特丹的 Our Lady of the Hospital 医院进行。
这是一项回顾性、嵌套病例对照研究，纳入了同时使用影响钾的药物的住院患者。病例为血清钾≥5.5mmol/L 的患者，对照组为血清钾水平正常的患者。病例与对照的比例为 1:2。记录并统计分析与高钾血症相关的已知危险因素：糖尿病、充血性心力衰竭、肾功能下降、年龄较大、性别以及肝素、地高辛、非甾体抗炎药、β受体阻滞剂、钙调神经磷酸酶抑制剂和甲氧苄啶的使用。
确定同时使用钾补充剂、RAAS 抑制剂和/或保钾利尿剂导致高钾血症的危险因素。
在纳入的 774 名患者中，有 52 名患者发生高钾血症；患病率为 6.7%。唯一发现与高钾血症显著相关的危险因素是肾功能下降，表现为估算肾小球滤过率（eGFR）<50ml/min（调整后的 OR 5.08；95%CI 2.46-10.48）。未发现其他测试的危险因素有显著意义。
本研究表明，在使用影响钾的药物的患者中，肾功能下降（eGFR<50ml/min）与高钾血症风险增加 5 倍相关。虽然之前的研究表明，高钾血症在 eGFR<30 或 40ml/min 以下的阈值时显著增加，但我们观察到 eGFR<50ml/min 的阈值较低。因此，建议医生在监测肾功能下降患者使用影响钾的药物时应特别警惕。
