Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Pharmacy, Tokyo Women's Medical University, Medical Centre East: 2-1-10, Nishiogu, Arakawa-ku, Tokyo, 116-0011, Japan.
J Infect Chemother. 2021 Nov;27(11):1607-1613. doi: 10.1016/j.jiac.2021.07.011. Epub 2021 Jul 21.
Sulfamethoxazole/trimethoprim causes hyperkalemia; however, the effect of sulfamethoxazole/trimethoprim dose and co-administered glucocorticoids on hyperkalemia has not been clarified.
This single-center, retrospective, observational cohort, chart review study involving patients (>20 years) who were treated with sulfamethoxazole/trimethoprim was conducted at Tokyo Women's Medical University, Medical Center East from June 2015 to May 2019. Multivariate Cox proportional hazard model was used to identify risk factors for hyperkalemia (serum potassium level > 5.5 mEq/L). Additionally, Kaplan-Meier curve analyzed the cumulative incidence of hyperkalemia focusing on sulfamethoxazole/trimethoprim dose and concomitant use of glucocorticoids with mineralocorticoid activity.
Among 333 patients, 44 (13%) patients developed hyperkalemia associated with sulfamethoxazole/trimethoprim use for over 49 (interquartile range; 17-233) days. We found associations between the time to hyperkalemia development and sulfamethoxazole/trimethoprim dose (hazard ratio 1.238, 95% confidence interval 1.147-1.338, p < 0.001) and glucocorticoid use (hazard ratio 0.678, 95% confidence interval 0.524-0.877, p = 0.003). Interestingly, the Kaplan-Meier curves revealed that the concomitant use of glucocorticoids did not attenuate the risk of hyperkalemia in patients receiving high-dose sulfamethoxazole/trimethoprim (p = 0.747), whereas concomitant use of glucocorticoids significantly reduced the risk of hyperkalemia in patients receiving non-high dose sulfamethoxazole/trimethoprim (p < 0.001).
High-dose sulfamethoxazole/trimethoprim is a significant predictor of hyperkalemia. The effect of glucocorticoids on hyperkalemia varies depending on the sulfamethoxazole/trimethoprim dose.
磺胺甲恶唑/甲氧苄啶会引起高钾血症；然而，磺胺甲恶唑/甲氧苄啶的剂量和同时使用的糖皮质激素对高钾血症的影响尚未阐明。
本单中心、回顾性、观察性队列、病历回顾研究纳入了 2015 年 6 月至 2019 年 5 月在东京女子医科大学医疗中心接受磺胺甲恶唑/甲氧苄啶治疗的（年龄大于 20 岁）患者。采用多变量 Cox 比例风险模型确定高钾血症（血清钾水平>5.5mEq/L）的危险因素。此外，Kaplan-Meier 曲线分析了重点关注磺胺甲恶唑/甲氧苄啶剂量和同时使用具有盐皮质激素活性的糖皮质激素的高钾血症累积发生率。
在 333 例患者中，44 例（13%）患者在使用磺胺甲恶唑/甲氧苄啶超过 49 天（四分位距：17-233 天）后出现高钾血症。我们发现高钾血症发展时间与磺胺甲恶唑/甲氧苄啶剂量（风险比 1.238，95%置信区间 1.147-1.338，p<0.001）和糖皮质激素使用（风险比 0.678，95%置信区间 0.524-0.877，p=0.003）之间存在关联。有趣的是，Kaplan-Meier 曲线显示，在接受高剂量磺胺甲恶唑/甲氧苄啶治疗的患者中，同时使用糖皮质激素并没有降低高钾血症的风险（p=0.747），而在接受非高剂量磺胺甲恶唑/甲氧苄啶治疗的患者中，同时使用糖皮质激素显著降低了高钾血症的风险（p<0.001）。
高剂量磺胺甲恶唑/甲氧苄啶是高钾血症的一个重要预测因素。糖皮质激素对高钾血症的影响取决于磺胺甲恶唑/甲氧苄啶的剂量。
