中国门诊患者高钾血症分布及诊疗现状的流行病学研究

Epidemiology and treatment pattern of hyperkalemia among outpatients in China:a descriptive study using an administrative database in China

目的描述我国门诊患者高钾血症的发生率、诊断率、治疗率和复查率。方法利用全军合理用药监测网数据管理中心数据库,提取2015年~2017年门诊血钾检测、诊断和用药记录。纳入全部至少有1次血钾检测记录的18岁以上门诊患者。对如下指标在不同人群、季节和地区中的分布进行了描述性分析:所有门诊就诊且合并慢性疾病(慢性肾脏病、心力衰竭、糖尿病和高血压)患者中高钾血症患者比例,高钾血症诊断率、治疗率和7日内复查率。结果2015~2017年间,共纳入至少有1次血钾检测记录的患者2,997,634例,其中115,826例(3.86%)患者至少发生过1次高钾血症(血钾>5.0mmol/L)。在合并慢性肾脏病、心力衰竭、糖尿病和高血压的门诊患者中,高钾血症患者比例依次为22.89%、12.54%、7.11%和6.51%。本研究中门诊患者高钾血症诊断率为2.53%,总体治疗率为8.69%,7日内血钾复查率为11.41%。结论我国门诊患者中高钾血症并不少见。慢性肾脏病、心力衰竭、糖尿病和高血压患者中高钾血症发生率高于其他患者,且更严重。高钾血症的诊断率、治疗率和复查率均较低,应加强门诊患者高钾血症的识别和管理。

Objectives The aim of this study was to evaluate the proportion of hyperkalemia,rates of the diagnosis and treatment,and rate of retesting for hyperkalemia among outpatients in China.Methods Data were derived from Beijing Data Center for Rational Use of Drugs.Patients who accessed outpatient services(aged≥18 years old)with record(s)of serum potassium(S-K)between Jan.1st,2015 and Dec.31st,2017 were included.The data about laboratory test,diagnosis and treatment were analyzed.The main outcomes including proportion of hyperkalemia patients,diagnosis rate,treatment rate and S-K retesting rate were analyzed.The geographic and seasonal distributions of the outcomes were examined.Results A total of 2,997,634 patients with at least one S-K record were analyzed.Among these patients,115,826(3.86%)experienced hyperkalemia(S-K>5.0mmol/L).In patients with chronic kidney disease,heart failure,diabetes mellitus and hypertension,the rates of patients who experienced hyperkalemia were 22.89%,12.54%,7.11%and 6.51%,respectively.In outpatients,the overall rate of hyperkalemia was 2.53%.In patients with hyperkalemia,the overall hyperkalemia treatment rate was 8.69%,and the overall retesting rate within 7 days was 11.41%.Conclusions Hyperkalemia is an abnormality not rare in adult outpatients in China.The rate and severity of hyperkalemia were higher in patients with chronic kidney disease,heart failure,hypertension and diabetes compared to those in the overall outpatients.However,the rates of diagnosis,treatment and retesting for hyperkalemia in outpatients were insufficient,suggesting that the recognition and management of hyperkalemia in outpatients should be emphasized.