Zhang Danyang, Wang Yukun, Jiang Shimin, Li Wenge
Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.
Department of Biomedical Engineering, Xuanwu Hospital, Capital Medical University, Beijing, China.
Ren Fail. 2025 Dec;47(1):2445157. doi: 10.1080/0886022X.2024.2445157. Epub 2025 Jan 8.
Adjusting dietary potassium intake based on 24-hour urinary potassium excretion is the primary method of preventing hyperkalemia. Currently, there is no accurate and convenient method for calculating maximum 24-hour urinary potassium excretion in kidney failure without replacement therapy patients. We developed and validated two new models to assess the upper limit of dietary potassium consumption in this high-risk cohort, using the maximum 24-hour urinary potassium excretion as a proxy.
The data of 145 kidney failure without replacement therapy patients with hyperkalemia was gathered. The prediction models were developed using multilayer perceptron and stepwise multiple linear regression utilizing a stochastic sample of 102 (70%) patients. Within the rest 43 (30%), the performance of various models was independently verified.
The two new models had low bias (-0.02 and -0.57 mmol/24h vs 66.74 and 79.91 mmol/24h, mean absolute error = 5.57 and 5.22 vs 68.95 and 81.37), high accuracy (percentage of calculated values within_±30% of measured values = 83.45% and 84.14% vs 0.00% and 0.00%), high correlation with measured values (Spearman correlation coefficient = 0.72 and 0.72 vs 0.46 and 0.45, intraclass correlation coefficient = 0.67 and 0.70 vs 0.03 and 0.03) and high agreement with 24-hour urine potassium measurements (95% limits of agreement of Bland-Altman plot = 13.70 and 13.20 mmol/24h vs 113.8 and 191.3 mmol/24h).
These new models show high clinical application value for the calculation of maximum 24-hour urinary potassium excretion in kidney failure without replacement therapy patients with hyperkalemia.
根据24小时尿钾排泄量调整饮食钾摄入量是预防高钾血症的主要方法。目前，对于未接受替代治疗的肾衰竭患者，尚无准确便捷的方法来计算其最大24小时尿钾排泄量。我们开发并验证了两个新模型，以最大24小时尿钾排泄量为指标，评估这一高危人群饮食钾摄入量的上限。
收集了145例未接受替代治疗且患有高钾血症的肾衰竭患者的数据。使用多层感知器和逐步多元线性回归，以102例（70%）患者的随机样本建立预测模型。在其余43例（30%）患者中，独立验证各种模型的性能。
这两个新模型偏差较小（分别为-0.02和-0.57 mmol/24小时，而其他值为66.74和79.91 mmol/24小时；平均绝对误差分别为5.57和5.22，而其他值为68.95和81.37），准确性高（计算值在测量值±30%范围内的百分比分别为83.45%和84.14%，而其他值为0.00%和0.00%），与测量值高度相关（Spearman相关系数分别为0.72和0.72，而其他值为0.46和0.45；组内相关系数分别为0.67和0.70，而其他值为0.03和0.03），并且与24小时尿钾测量结果高度一致（Bland-Altman图的95%一致性界限分别为13.70和13.20 mmol/24小时，而其他值为113.8和191.3 mmol/24小时）。
这些新模型对于计算未接受替代治疗且患有高钾血症的肾衰竭患者的最大24小时尿钾排泄量具有较高的临床应用价值。
