Faculty of Health Science, Ontario Tech University (University of Ontario Institute of Technology), Oshawa, ON, Canada.
The School of Nutrition, Ryerson University, Toronto, ON, Canada.
Nutr Metab Cardiovasc Dis. 2020 Jun 9;30(6):1005-1013. doi: 10.1016/j.numecd.2020.02.010. Epub 2020 Feb 24.
Potassium-wasting (loop diuretics [LD]) and potassium-sparing (spironolactone) medications used for heart failure (HF) may alter renal potassium handling and confound the use of twenty-four-hour (24-h) urine collections as a surrogate marker for potassium intake, an effect that has been observed with dietary sodium assessment. The objective was to determine the strength of association between 24-h urine collections and weighed food records in assessing potassium intake in HF patients stratified by LD usage and spironolactone usage.
Stable outpatients with HF simultaneously completed two 24-h urine collections and two weighed food records on consecutive days. Analyses compared patients stratified by LD and/or spironolactone use. Pearson's correlation and the Bland-Altman method of agreement assessed the relationship between the techniques. Overall, 109 patients (61 ± 11 yrs, 74% male) were included. The mean difference in dietary potassium estimated between 24-h urine collections and food records was -353 ± 1043 mg (p < 0.01) for all patients, with no differences between measures among subgroups. The association between the two methods was r = 0.551 (95% CI, 0.373 to 0.852, p < 0.001) for LD users; r = 0.287 (95% CI, 0.01 to 0.570, p = 0.050) for LD non-users; r = 0.321 (95% CI, 0.13 to 0.798, p = 0.043) for spironolactone users, and; r = 0.534 (95% CI, 0.331 to 0.747, p < 0.001) for spironolactone non-users. There were no significant mean biases identified as part of the Bland-Altman analysis.
Among HF patients, potassium-wasting and potassium-sparing medications do not influence the agreement between the two methods in the assessment of potassium intake.
用于心力衰竭（HF）的排钾利尿剂（LD）和保钾利尿剂（螺内酯）可能会改变肾脏对钾的处理，从而混淆使用 24 小时尿液收集作为钾摄入量的替代标志物，这在评估膳食钠时已经观察到。本研究旨在确定在使用 LD 和/或螺内酯分层的 HF 患者中，24 小时尿液收集与称重食物记录评估钾摄入量之间的关联强度。
稳定的 HF 门诊患者连续两天同时完成两次 24 小时尿液收集和两次称重食物记录。分析比较了根据 LD 和/或螺内酯使用情况分层的患者。Pearson 相关和 Bland-Altman 一致性方法评估了两种技术之间的关系。总体而言，纳入了 109 名患者（61±11 岁，74%为男性）。所有患者的 24 小时尿液收集和食物记录估计的膳食钾差异平均值为-353±1043mg（p<0.01），但亚组之间无差异。两种方法之间的相关性在 LD 使用者中为 r=0.551（95%CI，0.373 至 0.852，p<0.001）；在 LD 非使用者中为 r=0.287（95%CI，0.01 至 0.570，p=0.050）；在螺内酯使用者中为 r=0.321（95%CI，0.13 至 0.798，p=0.043）；在螺内酯非使用者中为 r=0.534（95%CI，0.331 至 0.747，p<0.001）。在 Bland-Altman 分析中没有发现显著的平均偏差。
在 HF 患者中，排钾和保钾药物不会影响两种方法在评估钾摄入量方面的一致性。
