Mäenpää Jukka, Anderson Isobel, Owen Caroline A, Emerath Ulrika, Hughes Rod, Sultana Stefan R, Olsson Marita
Chief Medical Office, Research & Development, Patient Safety Biopharma, AstraZeneca, Gothenburg, Sweden.
Patient Safety Operations, Technology & Analytics, Global Patient Safety, AstraZeneca, Macclesfield, UK.
Int J Chron Obstruct Pulmon Dis. 2025 Mar 15;20:723-734. doi: 10.2147/COPD.S490620. eCollection 2025.
Hyperkalemia increases mortality in various patient populations. The risk of hyperkalemia in COPD patients is poorly recognized. Hyperkalemia may increase cardiovascular mortality during and soon after COPD exacerbations.
A cohort based on two clinical trials comprising 7968 patients with moderate-to-very severe COPD was analysed retrospectively for associations between hyperkalemia and common comorbidities such as chronic kidney disease, diabetes mellitus (DM), or renin-angiotensin-aldosterone system inhibitor use.
Overall, 6.4% of 7968 patients had hyperkalemia (5.3% Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2, 6.8% GOLD 3, and 8.0% GOLD 4). COPD severity was associated with significantly higher hyperkalemia risk in GOLD 3 (odds ratio [OR]=1.28, 95% CI 1.04-1.58) and GOLD 4 (OR=1.64, 95% CI 1.19-2.22) versus GOLD 2 patients. Hyperkalemia cases increased with decreasing renal function. Patients with moderate-to-severe renal impairment had >2-fold increased hyperkalemia risk versus those with normal renal function (OR=2.29, 95% CI 1.71-3.04). DM was associated with increased hyperkalemia risk (OR=1.28, 95% CI 1.02-1.59). Angiotensin-converting-enzyme inhibitor (ACEi) use increased hyperkalemia risk (OR=1.25, 95% CI 1.02-1.53). Unexpectedly, the association between hyperkalemia and renin-angiotensin-aldosterone system inhibitor use was statistically significant only in the normal renal function group (OR=1.63, 95% CI 1.13-2.34).
Hyperkalemia risk is higher in severe and very severe COPD patients than patients with moderate COPD. Hyperkalemia was also associated with decreasing kidney function, DM, and ACEi use. Serum potassium levels should be monitored regularly in patients with COPD, particularly those with GOLD-3 and 4.
高钾血症会增加各类患者群体的死亡率。慢性阻塞性肺疾病（COPD）患者发生高钾血症的风险尚未得到充分认识。高钾血症可能会增加COPD急性加重期间及之后不久的心血管死亡率。
对一项基于两项临床试验的队列研究进行回顾性分析，该队列包括7968例中重度至极重度COPD患者，分析高钾血症与常见合并症（如慢性肾脏病、糖尿病（DM）或使用肾素-血管紧张素-醛固酮系统抑制剂）之间的关联。
总体而言，7968例患者中有6.4%发生高钾血症（慢性阻塞性肺疾病全球倡议（GOLD）2期为5.3%，GOLD 3期为6.8%，GOLD 4期为8.0%）。与GOLD 2期患者相比，COPD严重程度与GOLD 3期（比值比[OR]=1.28，95%置信区间1.04-1.58）和GOLD 4期（OR=1.64，95%置信区间1.19-2.22）患者明显更高的高钾血症风险相关。高钾血症病例随肾功能下降而增加。中重度肾功能损害患者的高钾血症风险比肾功能正常者增加超过2倍（OR=2.29，95%置信区间1.71-3.04）。DM与高钾血症风险增加相关（OR=1.28，95%置信区间1.02-1.59）。使用血管紧张素转换酶抑制剂（ACEi）会增加高钾血症风险（OR=1.25，95%置信区间1.02-1.53）。出乎意料的是，高钾血症与肾素-血管紧张素-醛固酮系统抑制剂使用之间的关联仅在肾功能正常组有统计学意义（OR=1.63，95%置信区间1.13-2.34）。
重度和极重度COPD患者的高钾血症风险高于中度COPD患者。高钾血症还与肾功能下降、DM及使用ACEi有关。COPD患者，尤其是GOLD 3期和4期患者，应定期监测血清钾水平。
