Ahdoot Rebecca S, Hsiung Jui-Ting, Agiro Abiy, Brahmbhatt Yasmin G, Cooper Kerry, Fawaz Souhiela, Westfall Laura, Kalantar-Zadeh Kamyar, Streja Elani
Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine, Irvine, CA 92868, USA.
Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA.
J Clin Med. 2023 Jul 8;12(14):4562. doi: 10.3390/jcm12144562.
Liver disease is often associated with dysfunctional potassium homeostasis but is not a well-established risk factor for hyperkalemia. This retrospective cohort study examined the potential relationship between liver disease and recurrent hyperkalemia. Patients with ≥1 serum potassium measurement between January 2004 and December 2018 who experienced hyperkalemia (serum potassium >5.0 mmol/L) were identified from the United States Veterans Affairs database. A competing risk regression model was used to analyze the relationship between patient characteristics and recurrent hyperkalemia. Of 1,493,539 patients with incident hyperkalemia, 71,790 (4.8%) had liver disease (one inpatient or two outpatient records) within 1 year before the index hyperkalemia event. Recurrent hyperkalemia within 1 year after the index event occurred in 234,807 patients (15.7%) overall, 19,518 (27.2%) with liver disease, and 215,289 (15.1%) without liver disease. The risk of recurrent hyperkalemia was significantly increased in patients with liver disease versus those without (subhazard ratio, 1.34; 95% confidence interval, 1.32-1.37; < 0.0001). Aside from vasodilator therapy, the risk of recurrent hyperkalemia was not increased with concomitant medication. In this cohort study, liver disease was an independent risk factor strongly associated with recurrent hyperkalemia within 1 year, independent of concomitant renin-angiotensin-aldosterone system inhibitor or potassium-sparing diuretic use.
肝病常与钾稳态功能失调相关，但并非高钾血症公认的危险因素。这项回顾性队列研究探讨了肝病与复发性高钾血症之间的潜在关系。从美国退伍军人事务数据库中识别出在2004年1月至2018年12月期间有≥1次血清钾测量且经历过高钾血症（血清钾>5.0 mmol/L）的患者。采用竞争风险回归模型分析患者特征与复发性高钾血症之间的关系。在1,493,539例新发高钾血症患者中，71,790例（4.8%）在首次高钾血症事件发生前1年内患有肝病（一份住院记录或两份门诊记录）。首次事件发生后1年内，总体有234,807例患者（15.7%）出现复发性高钾血症，其中19,518例（27.2%）患有肝病，215,289例（15.1%）无肝病。与无肝病患者相比，肝病患者复发性高钾血症的风险显著增加（亚风险比为1.34；95%置信区间为1.32 - 1.37；P < 0.0001）。除血管扩张剂治疗外，联合用药并未增加复发性高钾血症的风险。在这项队列研究中，肝病是与1年内复发性高钾血症密切相关的独立危险因素，与肾素 - 血管紧张素 - 醛固酮系统抑制剂或保钾利尿剂的使用无关。
