Kim Miyeon, Lee Hwa Young, Kim Hyunwoo
Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, Korea.
Korean J Intern Med. 2025 May;40(3):468-481. doi: 10.3904/kjim.2024.160. Epub 2025 Apr 30.
BACKGROUND/AIMS: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are associated with the development of hyperkalemia. We evaluated the relationship between the serum aldosterone-to-potassium ratio (APR) and the risk of developing hyperkalemia in patients with chronic kidney disease (CKD) receiving ACEIs or ARBs.
One hundred eighty-six patients with stage 3-4 CKD receiving an ACEI or ARB for at least 3 months were evaluated. Serum aldosterone and potassium concentrations were measured simultaneously, and serum APR was calculated (ng/mL per mmol/L). Patients were divided into two groups for comparison according to the median value above or below 2.42. The primary outcome was the difference between the two groups in the development of hyperkalemia (defined as a serum potassium level > 5.5 mmol/L). Incidence rates and risk factors of hyperkalemia were assessed.
During the follow-up period, 144 hyperkalemic events in 81 patients (43.5%) were identified, yielding an incidence rate of 24.6 events/100 person-years. The incidence rate was significantly higher in patients with a low serum APR than in patients with a high APR (35.8 events/100 patient-years vs. 12.9 events/100 patient-years, p < 0.001). In addition, diabetes mellitus, history of hyperkalemia, CKD progression during the follow-up period, and low serum APR were predictors of the development of hyperkalemia.
Low serum APR was associated with the occurrence of hyperkalemia in patients with CKD receiving ACEIs or ARBs, suggesting that the identification of patients administered these drugs who are at high risk for hyperkalemia may be achieved using this index.
背景/目的：血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）与高钾血症的发生有关。我们评估了接受ACEI或ARB治疗的慢性肾脏病（CKD）患者血清醛固酮与钾比值（APR）与发生高钾血症风险之间的关系。
对186例接受ACEI或ARB治疗至少3个月的3-4期CKD患者进行评估。同时测定血清醛固酮和钾浓度，并计算血清APR（每毫摩尔/升中的纳克/毫升）。根据中位数2.42以上或以下将患者分为两组进行比较。主要结局是两组在高钾血症发生情况（定义为血清钾水平>5.5毫摩尔/升）上的差异。评估高钾血症的发生率和危险因素。
在随访期间，81例患者（43.5%）发生了144次高钾血症事件，发生率为24.6次/100人年。血清APR低的患者发生率显著高于血清APR高的患者（35.8次/100患者年 vs. 12.9次/100患者年，p<0.001）。此外，糖尿病、高钾血症病史、随访期间CKD进展以及血清APR低是高钾血症发生的预测因素。
血清APR低与接受ACEI或ARB治疗的CKD患者高钾血症的发生有关，这表明使用该指标可能有助于识别接受这些药物治疗且发生高钾血症风险高的患者。
