Health Economics and Outcomes Research Ltd, Birmingham, UK.
Health Economics and Outcomes Research Ltd, Cardiff, UK.
Ren Fail. 2021 Dec;43(1):241-254. doi: 10.1080/0886022X.2020.1871012.
Patients with chronic kidney disease, especially those receiving hemodialysis (HD), are at risk of hyperkalemia (HK). This systematic review aimed to evaluate the prevalence of HK in patients with renal disease receiving HD and collate evidence on the effect of HK and differing HD patterns (i.e., long vs. short inter-dialytic intervals [LIDI and SIDI, respectively] in a thrice weekly schedule) on mortality.
Comprehensive searches were conducted across six databases and selected conference proceedings by two independent reviewers up to September 2020. A hundred and two studies reporting frequency of HK, mortality, or cardiovascular (CV) outcomes in adult patients with acute, chronic or end-stage renal disease in receipt of HD were included. Narrative synthesis of results was undertaken with key findings presented in tables and figures.
Median prevalence of HK in patients with renal disease receiving HD was 21.6% and increased in patients receiving concomitant medications - mainly renin-angiotensin-aldosterone system inhibitors and potassium-sparing diuretics. Associations between elevated potassium levels and increased risk of both all-cause and CV mortality in the HD population were consistent across the included studies. In addition, there was a rise in all-cause and CV mortality on the day following LIDI compared with the day after the two SIDIs in patients on HD.
Evidence identified in this systematic review indicates a relationship between HK and LIDI with mortality in patients with renal disease receiving HD, emphasizing the need for effective monitoring and management to control potassium levels both in emergency and chronic HD settings.
患有慢性肾脏病（CKD）的患者，尤其是接受血液透析（HD）治疗的患者，存在高钾血症（HK）的风险。本系统评价旨在评估接受 HD 治疗的肾病患者中 HK 的患病率，并整理关于 HK 和不同 HD 模式（即每周三次透析时的长间隔与短间隔[LIDI 和 SIDI]）对死亡率的影响的证据。
两位独立评审员通过综合检索六个数据库和选定的会议记录，检索截至 2020 年 9 月的相关文献。纳入了 102 项研究，这些研究报告了在接受 HD 治疗的急性、慢性或终末期 CKD 成年患者中 HK 的频率、死亡率或心血管（CV）结局。结果以表格和图形形式呈现，并进行了关键发现的叙述性综合。
接受 HD 治疗的 CKD 患者中 HK 的中位患病率为 21.6%，并在接受联合用药（主要是肾素-血管紧张素-醛固酮系统抑制剂和保钾利尿剂）的患者中增加。在包括的研究中，HK 水平升高与 HD 人群全因和 CV 死亡率增加之间存在一致的相关性。此外，与两次 SIDI 后的一天相比，在接受 HD 治疗的患者中，LIDI 后的一天全因和 CV 死亡率上升。
本系统评价中确定的证据表明，在接受 HD 治疗的 CKD 患者中，HK 与 LIDI 与死亡率之间存在关系，这强调了在紧急和慢性 HD 环境中需要有效监测和管理以控制钾水平。
