Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria.
Int J Clin Pract. 2021 Jan;75(1):e13653. doi: 10.1111/ijcp.13653. Epub 2020 Aug 27.
No data concerning the prevalence and risk factors of dyskalemia in acute kidney injury (AKI) exist. We investigated (a) prevalence rates, (b) risk factors and (c) outcome of hypo- and hyperkalemia in emergency patients.
In this cross-sectional analysis, all patients admitted to the emergency department of a large public hospital in Switzerland between January 1st 2017 and December 31st 2018 with measurements of creatinine and potassium were included. Baseline characteristics, medication and laboratory data were extracted. Chart reviews were performed to identify patients with a diagnosis of chronic kidney disease (CKD) and to extract their baseline creatinine. For all other patients, the ADQI backformula was used in order to calculate baseline creatinine. AKI was graduated using creatinine criteria of the acute kidney injury network. Binary logistic regression analysis was used to identify risk factors for appearance of hyperkalemia and outcome.
AKI was found in 8% of patients. Hyperkalemia was present in 13% and hypokalemia in 11% of patients with AKI. AKI stage, potassium-sparing diuretics, ACE inhibitors and underlying CKD were the strongest risk factors for hyperkalemia. Hyperkalemia as well as profound hypokalemia were independently associated with prolonged length of stay and in-hospital mortality. The study is limited by its dependency on chart review data in order to identify patients with chronic kidney disease and by limitations of the ADQI backformula to calculate baseline creatinine.
Dyskalemias are common in emergency patients with AKI and are independent risk factors for adverse outcomes. Potassium-sparing diuretics, ACE-inhibitors, AKIN stage and CKD are predictors of hyperkalemia in AKI.
目前尚无关于急性肾损伤（AKI）中电解质紊乱（包括低钾血症和高钾血症）的患病率和危险因素的数据。本研究旨在调查：（a）急症患者低钾血症和高钾血症的患病率；（b）危险因素；（c）结局。
这是一项横断面研究，纳入了 2017 年 1 月 1 日至 2018 年 12 月 31 日期间瑞士一家大型公立医院急诊科收治的所有检测了肌酐和钾的患者。记录了患者的基线特征、用药和实验室数据。通过病历回顾确定了慢性肾脏病（CKD）患者，并提取了他们的基线肌酐值。对于其他患者，使用 ADQI 后推公式计算了基线肌酐值。根据急性肾损伤网络的肌酐标准，对 AKI 进行分级。采用二元逻辑回归分析识别高钾血症的发生和结局的危险因素。
8%的患者发生 AKI。AKI 患者中 13%存在高钾血症，11%存在低钾血症。AKI 分期、保钾利尿剂、ACE 抑制剂和基础 CKD 是高钾血症的最强危险因素。高钾血症和严重低钾血症与住院时间延长和院内死亡率增加独立相关。该研究的局限性在于依赖病历回顾数据来识别 CKD 患者，以及 ADQI 后推公式在计算基线肌酐值方面的局限性。
急症患者中 AKI 伴发的电解质紊乱很常见，是不良结局的独立危险因素。保钾利尿剂、ACE 抑制剂、AKIN 分期和 CKD 是 AKI 患者高钾血症的预测因素。
