维持性血液透析患者透析前后血钾状态及其影响因素分析

Analysis of factors associating with hyperkalemia in patients undergoing maintained haemodialysis

目的观察维持性血液透析(MHD)患者透析前后血清钾离子浓度,并探讨影响其变化的临床因素。方法57例维持性血液透析患者,根据其是否服用血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB),将患者分为ACEI组、ARB组及非ACEI/ARB组;记录各组患者残余尿量及有无高钾血症临床表现,并取透析前后静脉血,测定血清钾、尿素氮(BUN)、血肌酐(SCr)、二氧化碳结合力(CO2CP)等指标,分析各组患者血钾浓度变化的差异及血钾浓度与其他临床因素之间的相关性。结果透析前高钾血症发生率36.8%(21/57),其中76.2%(16/21)患者无高钾血症的临床表现;ACEI组、ARB组、非ACEI/ARB组透析前血钾水平分别为(6.00±0.95)mmol/L(、5.60±0.25)mmol/L(、4.72±0.95)mmol/L,其中ACEI组与其他2组之间差异有统计学意义(P<0.01),而ARB组与非ACEI/ARB组患者透析前血钾浓度差异无统计学意义(P>0.05);透析前血钾离子浓度与SCr、BUN浓度显著正相关(r=0.415、0.522,均P<0.01),但与患者残余尿量和透析前后CO2CP浓度变化无明显相关(r=0.559、0.411,均P>0.05)。结论MHD患者透析前高钾血症发病率高,临床表现较隐匿,易被忽视;残余尿量并非判断患者是否易出现透析前高钾血症的可靠指标;增加透析次数,减量或停服ACEI,限制饮食中钾摄入是防治透析前高钾血症的有效方法。

Objective Hyperkalaemia is a common problem in maintained hemodialysis（MHD） patients. The aim was to assess the factors associating with hyperkalemia in these patients. Methods Respectively, 57 MHD patients were enrolled in this study. Patients were divided into three groups,including angiotensin converting enzyme inhibition （ACEI） group,angiotensin Ⅱ receptor blocker（ARB） group or non-ACEI non-ARE group. The clinical factors such as urine volume,serum potassium, creatinine （SCr） and urea, carbon dioxide combining power（CO2CP） were studied. Results The incidence of hyperkalemia before hemodialysis in MHD patients was 36.8% （21/57）, of which 76.2% （16/21） being asymptomatic. There was significant difference in the serum potassium changes before and after HD between ACEI groups and the other two groups （ P〈0. 01）. However, there was no significant difference between ARB group and non-ACEI non-ARB group （ P 〉0.05）. According to Spearman analysis,an elevated serum potassium level had the strongest positive correlation with serum creatinine and urea level （ P 〈0.01）, but not with urine volume or CO2CP（ P 〉0. 05）. Conclusion MHD patients are prone to hyperkalemia and its symptoms often are delitescent. Urine volume is not a reliable indicator about hyperkalemia. Caution should be exercised when using ACEI in these patients. Increasing HD frequency and constraining the diet potassium intake are considerable approach to avoid hyperkalemia.