维持性血液透析患者高钾血症与血管紧张素Ⅱ受体拮抗剂类药物应用的关系分析

Relationship Analyses of ARB and Hyperkalemia in Maintenance Hemodialysis Patients

目的分析维持性血液透析患者应用血管紧张素U受体拮抗剂(ARB),与其发生高钾血症的关系。方法收集2013年9月-2015年3月在沈阳市第四人民医院血液净化中心,进行维持性血液透析治疗患者的临床资料,包括透析次数、残尿量、糖尿病病史,以及应用ARB和卩受体阻滞剂情况等。根据患者是否使用ARB将入选患者分为ARB组和非ARB组,分别于2013年9月、2014年3月、2014年9月、2015年3月4个时间点检测并比较两组透析前血清钾、血肌肝、血尿素氮和二氧化碳结合力水平,以及高钾血症及严重高钾血症发生率。结果4个时间点,随着纳入病例数的逐渐增加,虽然两组基线资料发生改变,两组间个别资料差异有统计学意义(P<0.05),但两组高钾血症和严重高钾血症发生率差异均无统计学意义(P>0.05)。结论应用ARB类药物并不会使维持性血液透析患者高钾血症的发生率增加,应用ARB类药物也不是引起维持性血液透析患者高钾血症的主要原因,高钾血症不是ARB类药物在维持性血液透析患者中临床应用的禁忌证。

Objective To analyze the relationship in the use of angiotension receptor antagonist(ARB)and hyperkalemia occurrence in maintenance hemodialysis patients.Methods The clinical data of maintenance hemodialysis patients from September 2013 to March 2015 in the Blood Purification Center of The Fourth People's Hospital of Shenyang were collected,including dialysis frequency,residual urine volume,diabetes history,application history of ARB and β-receptor blocker.Patients were divided into ARB group and non-ARB group according to whether ARB was used.In September 2013,March 2014,September 2014 and March 2015,the levels of serum potassium,serum creatinine,blood urea nitrogen and carb on dioxide binding capacity before dialysis were detected,as well as the incidence of hyperkalemia and severe hyperkalemia were compared between the two groups.Results At four time points,with the gradual increase of the in eluded cases,although the baseline data of the two groups changed,the difference of individual data between the two groups was significant(P<0.05),but there was no significant difference in the incidence of hyperkalemia and severe hyperkalemia between the two groups(P>0.05).Conclusion The use of ARB drugs neither increase the incidence of hyperkalemia in maintenancc hemodialysis patients,nor the main cause of hyperkalemia in maintenance hemodialysis patients.Hyperkalemia is not the contraindicatio n of clinical application of ARB drugs in maintenance hemodialysis patients.