慢性高钾血症的疾病负担与干预策略

The Disease Burden and Intervention Strategy for Chronic Hyperkalemia

慢性高钾血症(CHK)在肾病、心血管疾病及肾素血管紧张素醛固酮阻滞剂(RAASi)治疗患者中多见。其所带来的疾病负担,一方面,由于反复发作导致医疗支出增加;另一方面,随病情加重,死亡率随之上升。临床实践中,因未能及时、充分血钾检测及随访而低估其发生率。多项研究表明,对CHK高发人群持续有效的血钾管理,可显著提高生存等获益。对于CHK治疗药物选择,需结合患者疾病特征、药理机制及不良反应等。环硅酸锆钠(SZC)是一种对钾离子高选择性、全胃肠道结合钾的新型口服药物,对肾功能损害、心衰及应用RAASi患者均疗效显著,安全性好,长期使用SZC可降低CHK疾病负担。对于CHK高风险患者,需要考虑定期血钾监测、动态评估,SZC等药物干预,以实现CHK有效综合管理。

Chronic hyperkalemia(CHK)is highly prevalent in patients with chronic kidney disease(CKD),cardiovascular disease(CVD)and patients receiving renin angiotensin aldosterone blocker(RAASi)treatment.CHK brings a very heavy burden of disease.On the one hand,recurrent hyperkalemia leads to increased medical expenditures;on the other hand,the mortality rate increases with the severity of CHK.The incidence of CHK can be underestimated due to insufficient blood potassium testing and follow-up monitoring.With reference to a vast of data analysis from a multiple of nations,steadfast and continuous blood potassium management for high-risk population of CHK can bring essential survival benefits.It is necessary to consider the patient’s disease characteristics,drug mechanism and adverse reactions during selection of CHK treatment.Sodium zirconium cyclosilicate(SZC)is a new type of oral potassium-lowering drug which is highly selective binding to potassium ions in the entire gastrointestinal tract.Now it is evidently reported the efficacy and safety in patients with damaged kidney function,heart failure,and RAASi treatment.Long-term use of SZC can also reduce the disease burden of CHK.In order to achieve effective comprehensive management for patients with high risk of CHK,it necessitates to regularly monitor blood potassium in dynamic schedules,and initiate SZC usage for prevention and intervention of the recurrence.