Dolson G M, Ellis K J, Bernardo M V, Prakash R, Adrogué H J
Department of Medicine, Veterans Affairs Medical Center, Houston, TX 77030, USA.
Am J Kidney Dis. 1995 Aug;26(2):321-6. doi: 10.1016/0272-6386(95)90652-5.
Potassium depletion is a risk factor for cardiovascular diseases, including hypertension, and frequently is encountered in patients with end-stage renal disease. Since the treatment of end-stage renal disease might result in K+ depletion and postdialysis hypokalemia, we investigated the relationship between acute K+ removal by hemodialysis and changes in blood pressure at the completion of treatment compared with predialysis and 1-hour postdialysis blood pressure. The effects of three different dialysate potassium concentrations ([K+]d; 1.0, 2.0, and 3.0 mmol/L) were investigated in 11 patients. Hemodialysis-induced K+ removal, serum [K+], total body K+, and blood pressure were measured. The use of 1.0, 2.0, or 3.0 mmol/L [K+]d resulted in the removal of 77.0 +/- 6.5, 54.5 +/- 7.9, and 42.5 +/- 9.9 mmol of K+ per treatment, respectively (P < 0.05, [K+]d 1.0 v [K+]d 3.0). Predialysis and postdialysis serum [K+] were 4.9 +/- 0.2 and 3.6 +/- 0.1 mEq/L for 1.0 mmol/L [K+]d, 5.1 +/- 0.3 and 3.9 +/- 0.1 mEq/L for 2.0 mmol/L [K+]d, and 5.3 +/- 0.3 and 4.2 +/- 0.2 mEq/L for 3.0 mmol/L [K+]d, respectively (P < 0.001 for each [K+]d). The baseline total body K+ corrected for gender, age, and race was 92% of predicted normal level and did not change significantly with the use of different [K+]d. Blood pressure decreased during hemodialysis as excess fluid was removed, regardless of [K+]d. Significant increases in blood pressure did occur 1 hour postdialysis compared with levels measured at the completion of treatment ("rebound hypertension") when hemodialysis was performed with 1.0 and 2.0 mmol/L, but not with 3.0 mmol/L [K+]d.(ABSTRACT TRUNCATED AT 250 WORDS)
钾缺乏是包括高血压在内的心血管疾病的一个危险因素，在终末期肾病患者中经常出现。由于终末期肾病的治疗可能导致钾离子缺乏和透析后低钾血症，我们研究了血液透析急性清除钾离子与治疗结束时血压变化之间的关系，并与透析前和透析后1小时的血压进行比较。在11例患者中研究了三种不同透析液钾浓度（[K⁺]d；1.0、2.0和3.0 mmol/L）的效果。测量了血液透析引起的钾离子清除、血清[K⁺]、总体钾离子和血压。使用1.0、2.0或3.0 mmol/L [K⁺]d每次治疗分别清除77.0±6.5、54.5±7.9和42.5±9.9 mmol的钾离子（P<0.05，[K⁺]d 1.0与[K⁺]d 3.0比较）。对于1.0 mmol/L [K⁺]d，透析前和透析后血清[K⁺]分别为4.9±0.2和3.6±0.1 mEq/L；对于2.0 mmol/L [K⁺]d，分别为5.1±0.3和3.9±0.1 mEq/L；对于3.0 mmol/L [K⁺]d，分别为5.3±0.3和4.2±0.2 mEq/L（每种[K⁺]d均P<0.001）。根据性别、年龄和种族校正后的基线总体钾离子为预测正常水平的92%，使用不同的[K⁺]d时无显著变化。无论[K⁺]d如何，血液透析期间由于多余液体被清除，血压都会下降。当使用1.0和2.0 mmol/L [K⁺]d进行血液透析时，与治疗结束时测量的水平相比，透析后1小时血压确实显著升高（“反弹性高血压”），但使用3.0 mmol/L [K⁺]d时则没有。（摘要截断于250字）
