Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
Am J Nephrol. 2017;46(2):150-155. doi: 10.1159/000479011. Epub 2017 Jul 22.
The chronic use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker has been associated with hyperkalemia in patients with reduced renal function even after the initiation of hemodialysis. Whether such medications may cause a similar effect in peritoneal dialysis patients is not well established. So, the aim of our study was to analyze the impact of renin-angiotensin-aldosterone inhibitors on the serum levels of potassium in a national cohort of peritoneal dialysis patients.
A prospective, observational, nationwide cohort study was conducted. We identified all incident patients on peritoneal dialysis that had angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) prescribed for at least 3 months and a similar period of time without these medications. Patients were divided into 4 groups: Groups I and III correspond to patients using, respectively, an ACEi or ARB and then got the drug suspended; Groups II and IV started peritoneal dialysis without the use of any renin-angiotensin aldosterone system inhibitor and then got, respectively, an ACEi or ARB introduced. Changes in potassium serum levels were compared using 2 statistical approaches: (1) the non-parametric Wilcoxon test for repeated measures and (2) a crossover analysis.
Mean potassium serum levels at the first phase of the study for Groups I, II, III, and IV were, respectively, 4.46 ± 0.79, 4.33 ± 0.78, 4.41 ± 0.63, and 4.44 ± 0.56. Changes in mean potassium serum levels for Groups I, II, III, and IV were -0.10 ± 0.60, 0.02 ± 0.56, -0.06 ± 0.46, and 0.03 ± 0.50, respectively.
The use of ACEi and ARB was not associated with a greater risk for hyperkalemia in stable peritoneal dialysis patients independently of residual renal function.
即使在开始血液透析后，慢性使用血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂与肾功能降低的患者的高钾血症有关。这些药物在腹膜透析患者中是否会产生类似的作用尚不清楚。因此，我们的研究目的是分析肾素-血管紧张素-醛固酮抑制剂对腹膜透析患者血清钾水平的影响。
进行了一项前瞻性、观察性、全国性队列研究。我们确定了所有至少服用血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）3 个月以上且同期未服用这些药物的腹膜透析新发患者。患者分为 4 组：第 I 组和第 III 组分别对应使用 ACEi 或 ARB 然后停药的患者；第 II 组和第 IV 组开始腹膜透析时未使用任何肾素-血管紧张素-醛固酮系统抑制剂，然后分别引入 ACEi 或 ARB。使用 2 种统计方法比较血钾血清水平的变化：（1）重复测量的非参数 Wilcoxon 检验和（2）交叉分析。
研究第一阶段各组 I、II、III 和 IV 的血钾血清水平均值分别为 4.46 ± 0.79、4.33 ± 0.78、4.41 ± 0.63 和 4.44 ± 0.56。各组 I、II、III 和 IV 的血钾血清水平变化均值分别为-0.10 ± 0.60、0.02 ± 0.56、-0.06 ± 0.46 和 0.03 ± 0.50。
在稳定的腹膜透析患者中，无论残余肾功能如何，使用 ACEi 和 ARB 与高钾血症的风险增加无关。
