Phillips B M, Milner S, Zouwail S, Roberts G, Cowan M, Riley S G, Phillips A O
Insititute of Nephrology , Cardiff University School of Medicine , Cardiff , UK.
Department of Biochemistry and Immunology , Cardiff and Vale University Health Board, University Hospital of Wales , Cardiff , UK ; Department of Medical Biochemistry, School of Medicine , Alexandria University , Alexandria , Egypt.
Clin Kidney J. 2014 Apr;7(2):127-33. doi: 10.1093/ckj/sft158. Epub 2014 Jan 2.
Few studies have evaluated the prevalence of severe hyperkalaemia in unselected patient populations. We identified all episodes of severe hyperkalaemia occurring in 1 year, and described patient demographics, clinical response and outcome. We also assessed junior doctor knowledge of its causes and significance.
A retrospective interrogation of the database of the regional biochemical laboratory identified all episodes of severe hyperkalaemia (K≥ 6.5 mmol/L) occurring in 2011. The understanding of trainee doctors of the importance, causes and treatment of severe hyperkalaemia was assessed by structured questionnaire.
Severe hyperkalaemia was recorded in 433 samples (365 patients) giving a prevalence of 0.11%. Thirty-six per cent of episodes occurred in patients under the care of a nephrologist, who were significantly younger than those not under the care of a nephrologist. In the nephrology cohort, 86% occurred in patients with chronic kidney disease (CKD), the majority of which had CKD Stage 5. In the non-nephrology cohort, only 65% occurred in the context of CKD, which was equally distributed between Stages 3 and 5 CKD. In both patient groups, roughly 50% of episodes occurred in association with acute kidney injury (AKI). Acute mortality (death within 48 h of documented severe hyperkalaemia) was higher in the non-nephrology compared with the nephrology cohort. Time to repeat serum potassium was influenced by the clinical setting with shorter time to repeat for acute care compared with ward settings. Assessment of trainee doctor's knowledge suggested significant deficiencies in relation to severe hyperkalaemia.
The prevalence of severe hyperkalaemia was low and occurred predominantly in the context of CKD and/or AKI. The majority of episodes occurred in patients not under the care of a nephrologist. Variability in time to repeat serum potassium levels suggested deficiencies in care, and assessment of trainee doctor's knowledge suggests the need for further educational initiatives to highlight its importance.
很少有研究评估未经过筛选的患者群体中严重高钾血症的患病率。我们确定了1年内发生的所有严重高钾血症病例，并描述了患者的人口统计学特征、临床反应和结局。我们还评估了初级医生对其病因和重要性的了解情况。
对地区生化实验室数据库进行回顾性查询，确定2011年发生的所有严重高钾血症病例（血钾≥6.5 mmol/L）。通过结构化问卷评估实习医生对严重高钾血症的重要性、病因和治疗的理解。
在433份样本（365例患者）中记录到严重高钾血症，患病率为0.11%。36%的病例发生在肾病科医生照料的患者中，这些患者比未接受肾病科医生照料的患者明显年轻。在肾病科队列中，86%发生在慢性肾脏病（CKD）患者中，其中大多数为CKD 5期。在非肾病科队列中，只有65%发生在CKD背景下，且在CKD 3期和5期之间分布均匀。在两组患者中，约50%的病例与急性肾损伤（AKI）相关。与肾病科队列相比，非肾病科队列的急性死亡率（记录到严重高钾血症后48小时内死亡）更高。重复检测血清钾的时间受临床环境影响，急性护理环境下重复检测的时间比病房环境短。对实习医生知识的评估表明，他们对严重高钾血症的了解存在明显不足。
严重高钾血症的患病率较低，主要发生在CKD和/或AKI背景下。大多数病例发生在未接受肾病科医生照料的患者中。重复检测血清钾水平的时间存在差异，提示护理存在不足，对实习医生知识的评估表明需要进一步开展教育活动以突出其重要性。
