儿童肾移植后高钾性远端肾小管酸中毒的发生率及氟氢可的松的作用。

Incidence of hyperkalemic RTA in pediatric post-renal transplant patients and the role of fludrocortisone.

机构信息

Pediatric Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist hospital, Dammam, Saudi Arabia.

King Faisal University, College of Medicine, Alhasa, Saudi Arabia.

出版信息

Pediatr Transplant. 2021 Sep;25(6):e14029. doi: 10.1111/petr.14029. Epub 2021 May 22.

DOI:10.1111/petr.14029

PMID:34021680

Abstract

BACKGROUND

One of the most common forms of post-transplant tubulopathy is hyperkalemic (RTA). The true incidence of hyperkalemic RTA in pediatric patients has not yet been studied. (CNIs) remain mostly blamed. Most cases are managed with sodium bicarbonate and potassium binding resins. Few studies have addressed the role of fludrocortisone in managing such patients. This study aimed to assess the efficacy and safety of fludrocortisone in the treatment of post-transplant hyperkalemic RTA.

METHOD

This is a retrospective cohort study of all pediatric (aged ≤16 years) post-kidney transplant patients who were followed up in KFSH-D, Saudi Arabia from January 2015 until September 2019. A total of 136 pediatric post-renal transplant patients were reviewed, of these, 39 patients who were commenced on fludrocortisone post-transplant treatment and were followed up for at least 6 months after fludrocortisone initiation were included in this study.

RESULTS

The incidence of hyperkalemic RTA in our center was 60.6%. The medication requirements decreased significantly after fludrocortisone initiation. The median sodium bicarbonate dose decreased from 1.2 mEq/kg/day (range, 0.0-4.7) prior to fludrocortisone treatment to 0.0 mEq/kg/day (range, 0.0-4.3) at 6-month follow-up (p < .001). Similarly, the median (SPS) dose decreased from 1.2 g/kg/day (range, 0.0-4.0) before fludrocortisone treatment to 0.0 g/kg/day (range, 0.0-3.6) (p < .001) at 6-month follow-up. The initial mean potassium level 5.17 mmol/L ± 0.61SD dropped to 4.60 mmol/L ± 0.46SD at 6-month follow-up (p < .001). The initial mean serum bicarbonate level 22.31 mmol/L ± 3.67SD increased to 24.5 mmol/L ± 2.8SD at 6-month follow-up (p < .01). No effect on systolic and diastolic blood pressure was observed during follow-up.

CONCLUSION

Hyperkalemic RTA incidence was high in our cohort. Fludrocortisone is safe and effective drug in the treatment of post-kidney transplant hyperkalemic RTA.

摘要

背景

移植后肾小管病最常见的形式之一是高钾血症（RTA）。儿科患者高钾血症 RTA 的真实发病率尚未得到研究。（CNIs）仍然是主要原因。大多数病例采用碳酸氢钠和钾结合树脂治疗。很少有研究探讨氟氢可的松在治疗此类患者中的作用。本研究旨在评估氟氢可的松治疗移植后高钾血症 RTA 的疗效和安全性。

方法

这是一项回顾性队列研究，纳入 2015 年 1 月至 2019 年 9 月在沙特阿拉伯 KFSH-D 接受肾移植后随访的所有儿科（年龄≤16 岁）患者。共回顾了 136 例儿科肾移植后患者，其中 39 例在移植后开始接受氟氢可的松治疗，并在氟氢可的松开始治疗后至少随访 6 个月，纳入本研究。

结果

本中心高钾血症 RTA 的发病率为 60.6%。氟氢可的松治疗后药物需求明显下降。氟氢可的松治疗前，中位碳酸氢钠剂量从 1.2mEq/kg/天（范围，0.0-4.7）降至 0.0mEq/kg/天（范围，0.0-4.3）（p<0.001）。同样，氟氢可的松治疗前中位（SPS）剂量从 1.2g/kg/天（范围，0.0-4.0）降至 0.0g/kg/天（范围，0.0-3.6）（p<0.001）在 6 个月的随访中。初始平均血钾水平 5.17mmol/L±0.61SD 下降至 6 个月随访时的 4.60mmol/L±0.46SD（p<0.001）。初始平均血清碳酸氢盐水平 22.31mmol/L±3.67SD 增加至 6 个月随访时的 24.5mmol/L±2.8SD（p<0.01）。随访期间，收缩压和舒张压均无变化。