慢性肾脏病患者尿钾排泄的变化。
Changes in urinary potassium excretion in patients with chronic kidney disease.
机构信息
Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
出版信息
Kidney Res Clin Pract. 2016 Jun;35(2):78-83. doi: 10.1016/j.krcp.2016.02.001. Epub 2016 Feb 27.
BACKGROUND
Hyperkalemia is one of the more serious complications of chronic kidney disease (CKD), and the cause of potassium retention is a reduction in urinary potassium excretion. However, few studies have examined the extent of the decrease of urinary potassium excretion in detail with respect to decreased renal function.
METHODS
Nine hundred eighty-nine patients with CKD (CKD stages G1 and G2 combined: 135; G3a: 107; G3b: 170; G4: 289; and G5: 288) were evaluated retrospectively. Values for urinary potassium excretion were compared between CKD stages, and the associations between urinary potassium excretion and clinical parameters, including diabetes mellitus status and use of renin-angiotensin-aldosterone system inhibitors, were analyzed using a multivariable linear regression analysis.
RESULTS
Urinary potassium excretion gradually decreased with worsening of CKD (G5: 24.8 ± 0.8 mEq/d, P < 0.001 vs. earlier CKD stages). In contrast, the value of fractional excretion of potassium at CKD G5 was significantly higher than that at the other stages (30.63 ± 0.93%, P < 0.001). Multivariable linear regression analysis revealed that urinary potassium excretion was independently associated with urinary sodium excretion (standardized coefficient, 0.499), the estimated glomerular filtration rate (0.281), and serum chloride concentration (-0.086).
CONCLUSION
This study demonstrated that urinary potassium excretion decreased with reductions in renal function. Furthermore, urinary potassium excretion was mainly affected by urinary sodium excretion and estimated glomerular filtration rate in patients with CKD, whereas the presence of diabetes mellitus and use of renin-angiotensin-aldosterone system inhibitors were not associated with urinary potassium excretion in this study.
背景
高钾血症是慢性肾脏病（CKD）较严重的并发症之一，其病因是尿钾排泄减少。然而，很少有研究详细检查肾功能下降时尿钾排泄减少的程度。
方法
回顾性评估了 989 例 CKD 患者（CKD 1 期和 2 期合并：135 例；3a 期：107 例；3b 期：170 例；4 期：289 例；5 期：288 例）。比较了 CKD 各期的尿钾排泄值，并使用多变量线性回归分析，分析了尿钾排泄与临床参数（包括糖尿病状态和肾素-血管紧张素-醛固酮系统抑制剂的使用）之间的关系。
结果
随着 CKD 的恶化，尿钾排泄逐渐减少（G5：24.8±0.8 mEq/d，P<0.001 与早期 CKD 阶段相比）。相反，在 CKD G5 时，钾的分数排泄值明显高于其他阶段（30.63±0.93%，P<0.001）。多变量线性回归分析显示，尿钾排泄与尿钠排泄（标准化系数，0.499）、估计肾小球滤过率（0.281）和血清氯浓度（-0.086）独立相关。
结论
本研究表明，尿钾排泄随肾功能下降而减少。此外，在 CKD 患者中，尿钾排泄主要受尿钠排泄和估计肾小球滤过率的影响，而糖尿病的存在和肾素-血管紧张素-醛固酮系统抑制剂的使用与本研究中的尿钾排泄无关。
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