肾素-血管紧张素-醛固酮抑制剂与维持性血液透析患者高钾血症

Renin-angiotensin-aldosterone inhibitor and hyperkalemia in patients with maintenance hemodialysis

肾素-血管紧张素-醛固酮抑制剂(renin-angiotensin-aldosterone Inhibitor,RASi)在降低血压和维护心肾功能中发挥着重要的作用,但RASi会阻止醛固酮分泌并引起高钾血症(hyperkalemia)。鉴于RASi可能导致肾小球滤过率已经下降的慢性肾脏病(chronic kidney disease,CKD)患者血肌酐升高及高钾血症,此类药物在非透析CKD 4~5期患者中存在顾虑。而对于维持性血液透析(maintenance hemodialysis,MHD)人群,由于存在较多影响MHD患者血钾的因素(如饮食、清除率、药物等)且诸多因素间可能存在交互作用,RASi的安全性的问题尚有争议。

Renin-angiotensin-aldosterone inhibitor(RASi)plays an important role in lowering blood pressure and maintaining cardiac and renal functions,but it also blocks the secretion of aldosterone and causes hyperkalemia.Because RASi may aggravate the hyperkalemia and elevated serum creatinine that are already present in chronic kidney disease(CKD)patients due to reduced glomerular filtration rate,doctors usually prescribe RASi very cautiously to the non-dialysis CKD patients at stage 4-5.For CKD patients on maintenance hemodialysis,the safety of RASi is controversial due to the presence of many factors,such as diet,clearance and medications,that may have reciprocal actions each other and affect serum potassium.