环硅酸锆钠散对慢性肾脏病高钾血症患者短期降钾效果的临床观察

Short-term effect of sodium zirconium cyclosilicate on potassium lowering in chronic kidney disease patients with hyperkalemia

目的观察环硅酸锆钠散对慢性肾脏病高钾血症患者的短期降钾临床疗效。方法回顾性分析2020年5至6月于郑州大学第一附属医院肾内科就诊的慢性肾脏病合并高钾血症并服用环硅酸锆钠散的患者临床资料,分析短期治疗效果。结果纳入21例共24例次,年龄(48.9±13.5)岁,男14例,女7例。用药2 h后,静脉血钾水平由(5.85±0.52)mmol/L降至(5.15±0.43)mmol/L(P<0.001),降幅(0.71±0.43)mmol/L;10例次动脉血钾由(5.50±0.40)mmol/L降至(4.88±0.33)mmol/L(P<0.001),降幅(0.62±0.29)mmol/L。以初始静脉血钾水平分为3组,<5.5 mmol/L组4例患者血钾降幅(0.46±0.26)mmol/L,5.5~<6.0 mmol/L组11例患者血钾降幅(0.62±0.38)mmol/L,≥6.0 mmol/L组6例患者血钾降幅(1.04±0.45)mmol/L,3组间降钾幅度差异有统计学意义(P=0.045)。降钾幅度与用药前静脉钾水平呈正相关(r=0.603,P=0.004)。未发现与治疗有关的不良反应。结论环硅酸锆钠散可在短时间内有效降低慢性肾脏病患者的血钾水平。

Objective To investigate the efficacy of sodium zirconium cyclosilicate on emergency correction of hyperkalemia in chronic kidney disease patients.Methods Patients with chronic kidney disease who were admitted to the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from May to June 2020 were selected.Those who had hyperkalemia and took sodium zirconium cyclosilicate powder were finally included.The patient′s clinical data and laboratory results were collected.Results A total of 24 results were included from 21 patients.The age of patients was(48.9±13.5)years old.Fourteen patients were male,and 7 patients were female.After 2 hours of administration,the venous potassium level decreased from(5.85±0.52)mmol/L to(5.15±0.43)mmol/L(P<0.001,n=21),with an average decline of(0.71±0.43)mmol/L.Meanwhile,the arterial potassium level decreased from(5.50±0.40)mmol/L to(4.88±0.33)mmol/L(P<0.001,n=10),with an average decline of(0.62±0.29)mmol/L.Based on the initial venous potassium level,the patients were further divided into three groups.The average potassium decrease in<5.5 mmol/L group(4 patients),5.5-<6.0 mmol/L group(11 patients)and≥6.0 mmol/L group(6 patients)was(0.46±0.26)mmol/L,(0.62±0.38)mmol/L and(1.04±0.45)mmol/L,respectively.There was statistically significant difference of potassium reduction among the three groups(P=0.045).Moreover,the extent of potassium reduction was positively correlated with baseline venous potassium level(r=0.603,P=0.004,n=21).The study did not reveal any treatment-related adverse event.Conclusion Sodium zirconium cyclosilicate powder can rapidly and effectively reduce the serum potassium level in chronic kidney disease patients with hyperkalemia.