Wang F, Yang C, Gao B X, Zhang L X, Zhao M H, Wang J W
Department of Nephrology, Peking University First Hospital, Institute of Nephrology, Peking University/Key Laboratory of Renal Disease, National Health Commission of China/Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing 100034, China.
Zhonghua Yi Xue Za Zhi. 2021 Nov 16;101(42):3459-3465. doi: 10.3760/cma.j.cn112137-20210508-01087.
To estimate the prevalence of hyperkalemia and hypokalemia in patients with chronic kidney disease (CKD), analyze the influencing factors and explore the impact on disease prognosis. A total of 3 190 patients with CKD stage 1-4 from 39 tertiary clinical centers in China between November 2011 and December 2016 were recruited. The baseline characteristics of the patients were collected through face-to-face questionnaire investigation, physical examination and laboratory test. Meanwhile, the data of patient's end-stage renal disease, cardiovascular disease events and deaths were obtained up to December 2017 through active monitoring. The patients were categorized into three groups based on their baseline level of serum potassium (hypokalemia:<3.5 mmol/L, normal range: 3.5-<5.0 mmol/L, hyperkalemia: ≥5 mmol/L). Multi-nominal logistic regression was employed to evaluate the association between clinical characteristics and the presence of hyperkalemia or hypokalemia. The competing risk-based subdistribution Cox proportional hazards regression was used to assess the association between baseline level of serum potassium and various outcomes. The mean age of the patients was (50±14) years, with a male rate of 57.6% (1 839/3 190) and a majority of glomerulonephritis (59.7%, 1 668/2 792). Patients with CKD stage 3-4 accounted for 70.8% (2 260/3 190), and the mean level of serum potassium was (4.4±0.7) mmol/L. The prevalence of hypokalemia and hyperkalemia was 3.7% (=118) and 17.6% (=561), respectively. In the multivariable adjusted analysis, presence of history of cardiovascular disease (=0.33, 95%: 0.13-0.83, =0.019) and estimated glomerular filtration rate (=0.95, 95%: 0.91-0.98, =0.001) were inversely associated with hypokalemia, while use of thiazide or loop diuretic (=2.06, 95%: 1.51-2.81, <0.001) and estimated glomerular filtration rate (=1.13, 95%: 1.12-1.16, <0.001) were positively associated with hyperkalemia. After adjusting for relevant cardiovascular and renal risk factors, the result only showed a significant association between hypokalemia and risk of all-cause mortality (=2.12, 95%: 1.06-4.24, =0.034). Hypokalemia and hyperkalemia were not rare in patients with CKD in China, with the latter more prevalent. Hypokalemia was independently associated with the risk of death.
为估算慢性肾脏病（CKD）患者高钾血症和低钾血症的患病率，分析影响因素并探讨其对疾病预后的影响。选取2011年11月至2016年12月期间来自中国39家三级临床中心的3190例1 - 4期CKD患者。通过面对面问卷调查、体格检查和实验室检测收集患者的基线特征。同时，通过主动监测获取截至2017年12月患者的终末期肾病、心血管疾病事件及死亡数据。根据患者血清钾基线水平将其分为三组（低钾血症：<3.5 mmol/L，正常范围：3.5 - <5.0 mmol/L，高钾血症：≥5 mmol/L）。采用多项逻辑回归评估临床特征与高钾血症或低钾血症存在之间的关联。使用基于竞争风险的亚分布Cox比例风险回归评估血清钾基线水平与各种结局之间的关联。患者的平均年龄为（50±14）岁，男性比例为57.6%（1839/3190），以肾小球肾炎居多（59.7%，1668/2792）。CKD 3 - 4期患者占70.8%（2260/3190），血清钾平均水平为（4.4±0.7）mmol/L。低钾血症和高钾血症的患病率分别为3.7%（=118）和17.6%（=561）。在多变量校正分析中，心血管疾病病史（=0.33，95%置信区间：0.13 - 0.83，=0.019）和估算肾小球滤过率（=0.95，95%置信区间：0.91 - 0.98，=0.001）与低钾血症呈负相关，而噻嗪类或襻利尿剂的使用（=2.06，95%置信区间：1.51 - 2.81，<0.001）和估算肾小球滤过率（=1.13，95%置信区间：1.12 - 1.16，<0.001）与高钾血症呈正相关。在调整相关心血管和肾脏危险因素后，结果仅显示低钾血症与全因死亡风险之间存在显著关联（=2.12，95%置信区间：1.06 - 4.24，=0.034）。低钾血症和高钾血症在中国CKD患者中并不罕见，后者更为普遍。低钾血症与死亡风险独立相关。
