The George Institute for Global Health, UNSW Sydney, Sydney, Australia.
PLoS One. 2019 Mar 7;14(3):e0213192. doi: 10.1371/journal.pone.0213192. eCollection 2019.
Data on hyperkalemia frequency among chronic kidney disease (CKD) patients receiving renin-angiotensin aldosterone system inhibitors (RAASis) and its impact on subsequent RAASi treatment are limited. This population-based cohort study sought to assess the incidence of clinically significant hyperkalemia among adult CKD patients who were prescribed a RAASi and the proportion of patients with RAASi medication change after experiencing incident hyperkalemia. We conducted a retrospective, population-based cohort study (1 January 2013-30 June 2017) using Australian national general practice data from the NPS MedicineWise's MedicineInsight program. The study included adults aged ≥18 years who received ≥1 RAASi prescription during the study period and had CKD (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73m2). Study outcomes included incident clinically significant hyperkalemia (serum potassium >6 mmol/L or a record of hyperkalemia diagnosis) and among patients who experienced incident hyperkalemia, the proportion who had RAASi medication changes (cessation or dose reduction during the 210-day period after the incident hyperkalemia event). Among 20,184 CKD patients with a median follow-up of 3.9 years, 1,992 (9.9%) patients experienced an episode of hyperkalemia. The overall incidence rate was 3.1 (95% CI: 2.9-3.2) per 100 person-years. Rates progressively increased with worsening eGFR (e.g. 3.5-fold increase in patients with eGFR <15 vs. 45-59 ml/min/1.73m2). Among patients who experienced incident hyperkalemia, 46.6% had changes made to their RAASi treatment regimen following the first occurrence of hyperkalemia (discontinuation: 36.6% and dose reduction: 10.0%). In this analysis of adult RAASi users with CKD, hyperkalemia and subsequent RAASi treatment changes were common. Further assessment of strategies for hyperkalemia management and optimal RAASi use among people with CKD are warranted.
关于接受肾素-血管紧张素-醛固酮系统抑制剂 (RAASi) 的慢性肾脏病 (CKD) 患者高钾血症发生率的数据及其对随后 RAASi 治疗的影响有限。本基于人群的队列研究旨在评估接受 RAASi 治疗的成年 CKD 患者中临床显著高钾血症的发生率以及经历高钾血症事件后 RAASi 药物改变的患者比例。我们使用澳大利亚全国普通实践数据（来自 NPS MedicineWise 的 MedicineInsight 计划）进行了一项回顾性、基于人群的队列研究（2013 年 1 月 1 日至 2017 年 6 月 30 日）。该研究纳入了≥18 岁的成年人，他们在研究期间接受了≥1 次 RAASi 处方，并且患有 CKD（估算肾小球滤过率[eGFR] <60 ml/min/1.73m2）。研究结果包括临床显著高钾血症（血清钾 >6 mmol/L 或有高钾血症诊断记录）以及在经历高钾血症事件的患者中，在高钾血症事件发生后的 210 天内，RAASi 药物改变（停药或剂量减少）的比例。在 20184 例中位随访时间为 3.9 年的 CKD 患者中，1992 例（9.9%）患者发生了高钾血症。总体发生率为每 100 人年 3.1（95%CI：2.9-3.2）。随着 eGFR 的恶化，发生率逐渐增加（例如，eGFR <15 与 45-59 ml/min/1.73m2 相比增加了 3.5 倍）。在经历高钾血症的患者中，首次发生高钾血症后，有 46.6%的患者改变了 RAASi 治疗方案（停药：36.6%，剂量减少：10.0%）。在这项对接受 RAASi 的 CKD 成年患者的分析中，高钾血症和随后的 RAASi 治疗改变很常见。有必要进一步评估高钾血症管理策略和 CKD 患者 RAASi 最佳使用策略。
