维持性血液透析患者透析前后血钾水平的调查

Pre-dialysis and post-dialysis levels of serum potassium in patients with hemodialysis

目的研究维持性血液透析患者血液透析前和透析后的血钾水平及其变化。方法回顾性分析福建医科大学附属漳州市医院血液透析室的资料。以月为单位,分析2019年每月血液透析患者的透析前和透析后血钾水平。高钾血症的定义为:血清钾离子≥5.5 mmol/L,其中血钾≥6.5 mmol/L定义为严重高钾血症。低钾血症的定义为:血清钾离子≤3.5 mmol/L。配对t检验对比透析前后的同一患者的血钾水平,P<0.05为差异有统计学意义。结果2019年,每个月有359~383例患者在我院接受血液透析治疗。每个月在透析患者接受血钾的检测率为63.76%~81.79%,每个月透析前血钾的均值波动在4.71~5.08 mmol/L之间,全年的钾离子测定波动在2.8~8.69 mmol/L。每月检测中,低钾血症的患病率为0.40%~4.49%(9个月)。每月尚有6.79%~13.74%的患者血钾水平在3.5~4.0 mmol/L。每月测定中,高钾血症的患病率为13.74%~27.8%(11个月),其中1.22%~7.5%的患者血钾水平≥6.5 mmol/L。透析后血钾水平显著降低(P<0.05)。对比透析前,透析后血钾下降27.01%~29.05%,透析后血钾水平2.15~5.65 mmol/L。透析后低钾血症的发生率为40.08%~54.59%,其中8例次出现血钾低于2.5 mmol/L,50例次出现血钾2.5~3.0 mmol/L。结论每月尚有一定比例的维持性血液透析患者伴有低钾血症,关注患者的血钾水平,个体化的选择透析液钾离子浓度可能有益。

Objective To analyze retrospectively the pre-dialysis and post-dialysis levels of serum potassium and their changes in hemodialysis patients.Methods Data on hemodialysis patients from Hemodialysis Room of Zhangzhou Municipal Hospital Affiliated to Fujian Medical University were analyzed retrospectively The serum potassium levels of hemodialysis patients before and after hemodialysis in 2019 were analyzed with month as unit time.Hyperkalemia was defined as serum potassium ion≥5.5 mmol/L.Serum potassium≥6.5 mmol/L was defined as severe hyperkalemia.Hypokalemia was defined as serum potassium ion≤3.5 mmol/L.Paired t-test was used to compare the serum potassium levels of the same patient before and after dialysis,P<0.05 was regarded as statistically significant difference.Results In 2019,359-383 patients received hemodialysis treatment in our hospital every month.Among all of patients undergoing hemodialysis,63.76%~81.79%patients received tests of serum potassium levels in every month.The mean value of pre-dialysis serum potassium levels was 4.71~5.08 mmol/L.In 2019,the serum potassium measurement value ranged from 2.8 to 8.69 mmol/L.The prevalence of hypokalemia was 0.4%~4.49%(9 months).In 2019,6.79%~13.74%of patients had a level of serum potassium between 3.5 and 4.0 mmol/L.The prevalence of hyperkalemia was 13.74%to 27.8%(11 months).Totally 1.22%~7.5%of patients had a higher level of serum potassium ion(≥6.5 mmol/L).After dialysis,the level of serum potassium decreased significantly(P<0.05).Compared to that before dialysis,the level of blood potassium decreased by 27.01%~29.05%after dialysis.The level of post-hemodialysis serum potassium was 2.15~5.56 mmol/L.The prevalence of post-hemodialysis hypokalemia was 40.08%~54.59%.The level of post-hemodialysis serum potassium was<2.5 mmol/L in 8 patients and 2.5~3 mmol/L in 50 patients,retrospectively.Conclusions Monthly,some certain proportion of patients with maintenance hemodialysis still experience the complication of hypokalemia.Concern about serum potassium levels of those patients,and individualized selection of dialysate potassium concentration for different patients may be helpful.