Tsiagka Dimitra, Georgianos Panagiotis I, Pikilidou Maria I, Vaios Vasilios, Roumeliotis Stefanos, Syrganis Christos, Mavromatidis Konstantinos, Metallidis Simeon, Liakopoulos Vassilios, Zebekakis Pantelis E
Section of Nephrology and Hypertension, 1St Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636, Thessaloniki, Greece.
Therapeutiki Dialysis Center, Thessaloniki, Greece.
Int Urol Nephrol. 2022 Sep;54(9):2327-2334. doi: 10.1007/s11255-022-03142-3. Epub 2022 Feb 8.
Observational studies have shown that among patients on hemodialysis, hyperkalemia is strongly associated with excess risk for cardiovascular-related hospitalizations and sudden cardiac death. However, the actual burden of hyperkalemia, the rates of its recurrence and seasonality in its variation still remain unclear.
Between June 2020 and May 2021, 1786 mid-week pre-dialysis serum potassium (sK) measurements were retrospectively recorded from 149 patients receiving thrice-weekly hemodialysis in a single-center in Thessaloniki, Greece. The prevalence, recurrence and seasonal variation of hyperkalemia were assessed using three pre-specified sK thresholds (≥ 5.1, ≥ 5.5 and ≥ 6.0 mmol/L).
At baseline, 60.4%, 42.2% and 13.4% of patients had sK levels ≥ 5.1, ≥ 5.5 and ≥ 6.0 mmol/L, respectively. At any time-point during follow-up, 85.2%, 69.8% and 38.9% of patients experienced at least one hyperkalemic event ≥ 5.1, ≥ 5.5 and ≥ 6.0 mmol/L, respectively. Of the 104 patients experiencing an initial sK elevation ≥ 5.5 mmol/L, hyperkalemia at the same threshold reoccurred in 60.6% at month 1, in 47.1% at month 2 and in 46.1% at month 3 of follow-up. Seasonal variation was also observed, with the prevalence of hyperkalemia to be significantly higher in summer. Shorter delivered hemodialysis < 4 h/session (OR: 2.568; 95% CI 1.045-6.313) and the use of a high dialysate K concentration (OR: 14.646; 95% CI 2.727-78.647) were the 2 factors that were independently associated with hyperkalemia.
The present study shows that among hemodialysis patients, the rates of hyperkalemia prevalence and recurrence are very high, reflecting the large unmet need to identify more effective potassium-lowering therapeutic interventions in this high-risk population.
观察性研究表明，在接受血液透析的患者中，高钾血症与心血管相关住院和心源性猝死的额外风险密切相关。然而，高钾血症的实际负担、复发率及其变化的季节性仍不清楚。
在2020年6月至2021年5月期间，回顾性记录了希腊塞萨洛尼基一家单中心149例每周接受三次血液透析的患者在周中透析前的1786次血清钾（sK）测量值。使用三个预先设定的sK阈值（≥5.1、≥5.5和≥6.0 mmol/L）评估高钾血症的患病率、复发率和季节性变化。
基线时，分别有60.4%、42.2%和13.4%的患者sK水平≥5.1、≥5.5和≥6.0 mmol/L。在随访期间的任何时间点，分别有85.2%、69.8%和38.9%的患者经历了至少一次sK≥5.1、≥5.5和≥6.0 mmol/L的高钾血症事件。在104例初始sK升高≥5.5 mmol/L的患者中，在随访第1个月时，相同阈值的高钾血症复发率为60.6%，第2个月时为47.1%，第3个月时为46.1%。还观察到季节性变化，夏季高钾血症的患病率显著更高。每次透析时间较短<4小时（比值比：2.568；95%置信区间1.045 - 6.313）和使用高透析液钾浓度（比值比：14.646；95%置信区间2.727 - 78.647）是与高钾血症独立相关的两个因素。
本研究表明，在血液透析患者中，高钾血症的患病率和复发率非常高，这反映出在这一高危人群中，识别更有效的降钾治疗干预措施的需求尚未得到满足。
