Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano BMM di Reggio Calabria, Reggio Calabria, Italy.
Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR-IFC of Reggio Calabria, Reggio Calabria, Italy.
Intern Emerg Med. 2021 Oct;16(7):1803-1811. doi: 10.1007/s11739-021-02653-8. Epub 2021 Feb 11.
Hyperkalemia is a potential life-threatening condition among chronic kidney disease (CKD) patients. Available estimates of the burden of this alteration in CKD are mainly derived from large administrative databases. Since K measurements in patients in these databases are often dictated by clinical reasons, longitudinal studies including pre-planned measurements of potassium independently of clinical complication/symptoms may produce more reliable estimates of the frequency and the risk factors underlying hyperkalemia in CKD patients. We estimated the prevalence and the incidence of hyperkalemia in a longitudinal study in 752 stages 2-5 CKD patients lasting 3 years and including up to seven pre-planned assessment of key biochemical measurements including K. At baseline, 203 out of 752 patients (27%) had serum K > 5.0 mM/L and 33% had acidosis (HCO ≤ 22 mmol/L). Among those without hyperkalemia at baseline (n = 549), 284 patients developed this alteration across the 3-year follow-up. The point prevalence of hyperkalemia rose from 27% (baseline) to 30% (last visit) (P = 0.001). In a multivariate model, hyperkalemia at baseline [odds ratio (OR):7.29, 95% CI 5.65-9.41, P < 0.001], venous bicarbonate levels [OR (1 mmol/l): 0.92, 0.89-0.96, P < 0.001], eGFR [OR (1 ml/min/1.73m): 0.98, 0.97-0.99, P < 0.001], use of ACE inhibitors (OR: 1.68, 1.28-2.19, P < 0.001) and angiotensin II antagonists (OR: 1.30, 1.01-1.68, P = 0.045) were related to hyperkalemia over time. Of note, venous bicarbonate levels emerged as an independent risk factor of hyperkalemia over time also in a separate analysis of patients with and without hyperkalemia at baseline. In a cohort of CKD patients including pre-planned measurements of K, 27% of patients had hyperkalemia. Metabolic acidosis and the use of drugs interfering with renin-angiotensin system were the strongest modifiable risk factors for this potentially life-threatening alteration in CKD in longitudinal analyses in the whole study cohort and in patients developing de novo hyperkalemia over time.
高钾血症是慢性肾脏病（CKD）患者潜在的危及生命的病症。对 CKD 中这种改变的负担的现有估计主要来自大型行政数据库。由于这些数据库中的患者的 K 测量通常由临床原因决定，因此包括独立于临床并发症/症状的预先计划的钾测量的纵向研究可能会产生更可靠的估计值，从而了解 CKD 患者高钾血症的频率和潜在风险因素。我们在一项为期 3 年的 752 名 2-5 期 CKD 患者的纵向研究中估计了高钾血症的患病率和发病率，并包括多达 7 次预先计划的关键生化测量值（包括 K）评估。在基线时，752 名患者中有 203 名（27%）血清 K>5.0 mM/L，33%有酸中毒（HCO<22 mmol/L）。在基线时没有高钾血症的患者中（n=549），有 284 名在 3 年随访中出现这种改变。高钾血症的点患病率从 27%（基线）上升到 30%（最后一次就诊）（P=0.001）。在多变量模型中，基线时的高钾血症[比值比（OR）：7.29，95%置信区间（CI）5.65-9.41，P<0.001]、静脉碳酸氢盐水平[OR（1mmol/l）：0.92，0.89-0.96，P<0.001]、eGFR[OR（1ml/min/1.73m）：0.98，0.97-0.99，P<0.001]、使用 ACE 抑制剂（OR：1.68，1.28-2.19，P<0.001）和血管紧张素 II 拮抗剂（OR：1.30，1.01-1.68，P=0.045）与随时间推移的高钾血症相关。值得注意的是，静脉碳酸氢盐水平在基线时有或没有高钾血症的患者的单独分析中也是随时间推移发生高钾血症的独立危险因素。在包括预先计划的 K 测量的 CKD 患者队列中，有 27%的患者患有高钾血症。代谢性酸中毒和使用干扰肾素-血管紧张素系统的药物是整个研究队列和随时间推移出现新发高钾血症的患者中，导致 CKD 这种潜在危及生命的改变的最强可改变危险因素。
