Reardon L C, Macpherson D S
Department of Medicine, University of Pittsburgh, Pa., USA.
Arch Intern Med. 1998 Jan 12;158(1):26-32. doi: 10.1001/archinte.158.1.26.
Hyperkalemia is a potentially life-threatening complication resulting from the use of angiotensin-converting enzyme (ACE) inhibitors; data to guide the intensity of monitoring for or responding to hyperkalemia in outpatients are limited.
Case-control methodological procedures were used to identify risk factors for hyperkalemia. Outpatients prescribed ACE inhibitors during 1992 and 1993 at a Veterans Affairs medical center general medicine clinic were identified. Case patients had a potassium level higher than 5.1 mmol/L on the day of clinic visit while using an ACE inhibitor; controls had a potassium level lower than 5.0 mmol/L on the day of clinic visit while using an ACE inhibitor and had no elevated potassium level during the study period. Predictor variables measured included type and dosage of ACE inhibitor; serum chemistries; comorbidities; concurrent drug use; and age. Case patients were followed up for 1 year after the index episode of hyperkalemia. Follow-up variables included changes in therapy with ACE inhibitor, maximum potassium for each change, and mortality.
Of 1818 patients using ACE inhibitors, 194 (11%) developed hyperkalemia. Results of laboratory studies indicating a serum urea nitrogen level higher than 6.4 mmol/L (18 mg/dL), creatinine level higher than 136 mumol/L (1.5 mg/dL), congestive heart failure, and long-acting ACE inhibitors were independently associated with hyperkalemia; concurrent use of loop or thiazide diuretic agent was associated with reduced risk. After 1 year of follow-up, 15 (10%) of 146 case patients remaining on a regimen of an ACE inhibitor developed severe hyperkalemia (potassium level > 6.0 mmol/L). A serum urea nitrogen level higher than 8.9 mmol/L (25 mg/dL) and age more than 70 years were independently associated with subsequent severe hyperkalemia.
Mild hyperkalemia is common in medical outpatients using ACE inhibitors, especially in those with renal insufficiency or congestive heart failure. However, once hyperkalemia is identified during the use of ACE inhibitors, subsequent severe hyperkalemia is uncommon in patients younger than 70 years with normal renal function.
高钾血症是使用血管紧张素转换酶（ACE）抑制剂引起的一种潜在危及生命的并发症；指导门诊患者监测高钾血症或对其做出反应的强度的数据有限。
采用病例对照方法程序来确定高钾血症的危险因素。确定了1992年和1993年在一家退伍军人事务医疗中心普通内科门诊开具ACE抑制剂的门诊患者。病例患者在门诊就诊当天使用ACE抑制剂时血钾水平高于5.1 mmol/L；对照患者在门诊就诊当天使用ACE抑制剂时血钾水平低于5.0 mmol/L，且在研究期间血钾水平未升高。测量的预测变量包括ACE抑制剂的类型和剂量；血清化学指标；合并症；同时使用的药物；以及年龄。病例患者在高钾血症首发事件后随访1年。随访变量包括ACE抑制剂治疗的变化、每次变化时的最高血钾水平以及死亡率。
在1818例使用ACE抑制剂的患者中，194例（11%）发生了高钾血症。实验室研究结果表明，血清尿素氮水平高于6.4 mmol/L（18 mg/dL）、肌酐水平高于136 μmol/L（1.5 mg/dL）、充血性心力衰竭以及长效ACE抑制剂与高钾血症独立相关；同时使用袢利尿剂或噻嗪类利尿剂与风险降低相关。随访1年后，146例继续使用ACE抑制剂治疗方案的病例患者中有15例（10%）发生了严重高钾血症（血钾水平>6.0 mmol/L）。血清尿素氮水平高于8.9 mmol/L（25 mg/dL）和年龄超过70岁与随后的严重高钾血症独立相关。
轻度高钾血症在使用ACE抑制剂的内科门诊患者中很常见，尤其是在那些有肾功能不全或充血性心力衰竭的患者中。然而，一旦在使用ACE抑制剂期间发现高钾血症，对于肾功能正常的70岁以下患者，随后发生严重高钾血症的情况并不常见。
