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慢性肾脏病中高血压与高钾血症的认识及治疗策略

Understanding and Treatment Strategies of Hypertension and Hyperkalemia in Chronic Kidney Disease.

作者信息

Jo Sang Min

机构信息

Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

出版信息

Electrolyte Blood Press. 2023 Jun;21(1):24-33. doi: 10.5049/EBP.2023.21.1.24. Epub 2023 Jun 27.

Abstract

Hypertension and potassium imbalance are commonly observed in chronic kidney disease (CKD) patients. The development of hypertension would be related to several mechanisms. Hypertension is related to body mass index, dietary salt intake, and volume overload and is treated with antihypertensives. In CKD patients, managing hypertension can provide important effects that can slow the progression of CKD or reduce complications associated with reduced glomerular filtration rate. The prevalence of hyperkalemia and hypokalemia in CKD patients was similar at 15-20% and 15-18%, respectively, but more attention needs to be paid to treating and preventing hyperkalemia, which is related to a higher mortality rate, than hypokalemia. Hyperkalemia is prevalent in CKD due to impaired potassium excretion. Serum potassium level is affected by renin-angiotensin-aldosterone system inhibitors and diuretics and dietary potassium intake and can be managed by potassium restriction dietary, optimized renin-angiotensin-aldosterone system inhibitor, sodium polystyrene sulfonate, patiromer, and hemodialysis. This review discussed strategies to mitigate and care for the risk of hypertension and hyperkalemia in CKD patients.

摘要

高血压和钾失衡在慢性肾脏病(CKD)患者中很常见。高血压的发生与多种机制有关。高血压与体重指数、饮食盐摄入量和容量超负荷有关,可用抗高血压药物治疗。在CKD患者中,控制高血压可产生重要作用,能够减缓CKD的进展或减少与肾小球滤过率降低相关的并发症。CKD患者高钾血症和低钾血症的患病率分别相似,为15%-20%和15%-18%,但相较于低钾血症,高钾血症与更高的死亡率相关,因此在治疗和预防方面需要给予更多关注。由于钾排泄受损,高钾血症在CKD中很常见。血清钾水平受肾素-血管紧张素-醛固酮系统抑制剂、利尿剂以及饮食钾摄入量的影响,可通过限制饮食钾、优化肾素-血管紧张素-醛固酮系统抑制剂、聚苯乙烯磺酸钠、帕替罗姆和血液透析来控制。本综述讨论了减轻和护理CKD患者高血压和高钾血症风险的策略。

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