Assadi Farahnak, Mazaheri Mojgan, Rad Elaheh Malakan
Department of Pediatrics, Division of Nephrology, Children Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
Department of Pediatrics, Division of Nephrology, Rush University Medical Center, 445 East North Water Street, Suite 1804, Chicago, IL, USA.
Pediatr Cardiol. 2022 Jun;43(5):1064-1070. doi: 10.1007/s00246-022-02826-y. Epub 2022 Apr 7.
Hemodialysis patients with hypercalcemia are less likely to manifest the usual electrocardiographic changes associated with hyperkalemia than in those with normal renal function. This study was conducted to determine whether electrocardiography (ECG) is a reliable indicator to detect severe life-threatening hyperkalemia in non-dialysis CKD patients. The study was conducted at three referral university hospitals between July 2017 and June 2018. Severe hyperkalemia was defined as serum potassium concentration ≥ 8.0 mEq/L. Serum potassium, sodium, bicarbonate, calcium, and creatinine concentrations were measured and simultaneous 12-lead ECG was obtained. Patients with end-stage renal disease receiving renal replacement therapy were excluded. Also excluded were patients with the usual ECG abnormalities to hyperkalemia. Of the 438 patients screened, 10 (2.3%) aged 2-14 years with severe hyperkalemia and normal ECG findings were identified. Median serum potassium level was 8.6 mEq/L (range 8.2-9.0). All had regular sinus rhythm. P, QRS, ST segment, T morphology, PR and QT interval, and QRS duration were all normal. Hyperkalemia was associated with CKD, metabolic acidosis, and hypercalcemia in all cases. Therapy with intravenous 0.9% saline, sodium bicarbonate, glucose, insulin, calcium, and salbutamol corrected the hyperkalemia in 7 patients. The remaining three patients evinced arrhythmias requiring hemodialysis. Although rare, non-dialysis CKD patients with hypercalcemia may not manifest the usual electrographic abnormalities associated with hyperkalemia. Thus, a normal ECG finding in non-dialysis CKD patients should be interpreted with caution.
与肾功能正常的患者相比，患有高钙血症的血液透析患者不太可能表现出与高钾血症相关的常见心电图变化。本研究旨在确定心电图（ECG）是否是检测非透析慢性肾脏病（CKD）患者严重危及生命的高钾血症的可靠指标。该研究于2017年7月至2018年6月在三家转诊大学医院进行。严重高钾血症定义为血清钾浓度≥8.0 mEq/L。测量血清钾、钠、碳酸氢盐、钙和肌酐浓度，并同步记录12导联心电图。接受肾脏替代治疗的终末期肾病患者被排除在外。有高钾血症常见心电图异常的患者也被排除在外。在筛查的438例患者中，确定了10例（2.3%）年龄在2至14岁之间的严重高钾血症患者，其心电图结果正常。血清钾水平中位数为8.6 mEq/L（范围8.2 - 9.0）。所有患者均为窦性心律。P波、QRS波群、ST段、T波形态、PR间期和QT间期以及QRS波时限均正常。所有病例中，高钾血症均与CKD、代谢性酸中毒和高钙血症相关。7例患者通过静脉输注0.9%生理盐水、碳酸氢钠、葡萄糖、胰岛素、钙剂和沙丁胺醇治疗后高钾血症得到纠正。其余3例患者出现心律失常，需要进行血液透析。虽然罕见，但患有高钙血症的非透析CKD患者可能不会表现出与高钾血症相关的常见心电图异常。因此，对于非透析CKD患者心电图结果正常的情况应谨慎解读。
