慢性肾脏病患者血钾异常相关因素分析

Analysis of Related Factors of Serum Potassium Abnormality in Patients with Chronic Kidney Disease

目的分析慢性肾脏病患者(CKD)血钾异常的临床特点及其影响因素。方法选取2014年12月~2018年12月我院诊治的321例慢性肾脏病患者,记录患者性别、年龄、是否服用利尿剂、是否合并高血压、肾小球滤过率(eGFR)、血肌酐(Scr)、尿素氮(BUN)、二氧化碳(CO2)水平,观察慢性肾脏病患者血清钾的异常发生率,比较不同CKD分期(CKD1~5期)患者的血钾水平、不同血钾水平患者性别、年龄、是否服用利尿剂、是否合并高血压、eGFR、Scr、BUN、CO2等差异及其与血钾的相关性。结果 321例CKD患者中血钾异常36例,血钾异常发生率为11.21%。其中低钾血症19例、血钾正常患者285例、高钾血症17例;CKD1~2期156例,CKD3a期43例,CKD3b期40例,CKD 4~5期82例;CKD早期患者与CKD晚期患者血钾水平比较,差异有统计学意义(P<0.05);高钾血症患者高血压所占比例、eGFR、BUN、Scr水平高于血钾正常及低钾血症患者,差异有统计学意义(P<0.05);高钾血症患者血清CO2、服用利尿剂比例低于血钾正常及低钾血症患者,差异有统计学意义(P<0.05);不同血钾水平患者年龄、性别比较,差异无统计学意义(P>0.05);Logistic回归分析显示,血清钾水平与是否服用利尿剂、BUN、Scr呈正相关(P<0.05),与血清CO2、eGFR呈负相关(P<0.05)。结论慢性肾脏病患者血钾水平随CKD分期的进展逐期升高,服用利尿剂、BUN和Scr升高,eGFR和CO2水平降低的患者更容易发生高血钾症,临床应加强对患者肾功能指标的监测,有效控制血钾异常危险因素。

Objective To analyze the clinical features and influencing factors of serum potassium abnormalities in patients with chronic kidney disease(CKD). Methods A total of 321 patients with chronic kidney disease who were treated in our hospital from December 2014 to December 2018 were enrolled. The patient’s gender, age, diuretics, hypertension, glomerular filtration rate(eGFR), serum creatinine were recorded(Scr), urea nitrogen(BUN), carbon dioxide(CO2) levels, observe the abnormal incidence of serum potassium in patients with chronic kidney disease, compare the blood potassium levels of patients with different CKD stages(CKD1~5), gender of different blood potassium levels, age, whether taking diuretics, whether combined with hypertension, eGFR, Scr, BUN, CO2 and other differences and their correlation with serum potassium. Results Of the 321 patients with CKD, 36 had abnormal potassium levels, and the incidence of abnormal potassium was 11.21%. There were 19 cases of hypokalemia, 285 cases of normal potassium and 17 cases of hyperkalemia;156 cases of CKD1~2, 43 cases of CKD3a, 40 cases of CKD3b, 82 cases of CKD 4~5;early stage of CKD Compared with serum potassium levels in patients with advanced CKD, the difference was statistically significant( P<0.05). The proportion of hypertension, eGFR, BUN and Scr in patients with hyperkalemia were higher than those in patients with normal potassium and hypokalemia,the difference was statistically significant(P<0.05). The serum CO2 and diuretic ratio of patients with hyperkalemia were lower than those with normal potassium and hypokalemia, the difference was statistically significant(P<0.05);different potassium levels There was no significant difference in age and gender between the patients(P>0.05). Logistic regression analysis showed that serum potassium levels were positively correlated with diuretics,BUN and Scr(P<0.05), and negatively correlated with serum CO2 and eGFR(P<0.05).Conclusion The serum potassium level of patients with chronic kidney disease increases with the progression of CKD stage. The patients taking diuretics, BUN and Scr are elevated, and patients with decreased eGFR and CO2 levels are more likely to have hyperkalemia. The clinical function of patients should be strengthened. The monitoring of indicators effectively controls the risk factors of abnormal blood potassium.