高钾血症和肾素-血管紧张素-醛固酮系统抑制剂治疗与急性心力衰竭合并肾功能不全患者预后的相关性分析

Correlation Analysis of Hyperkalemia and Renin-Angiotensin-Aldosterone System Inhibitor Treatment with Prognosis in Patients with Acute Heart Failure and Renal Dysfunction

目的:探讨高钾血症和肾素-血管紧张素-醛固酮系统(RAAS)抑制剂治疗与急性心力衰竭(HF)合并肾功能不全患者预后的关系。方法:选取2017年1月~2021年8月期间本院收治的600例急性HF合并肾功能不全患者为研究对象,根据血钾水平将患者分为高钾血症组(>5.5mmol/L,n=205)、正常血钾组(3.5~5.5mmol/L,n=281)和低钾血症组(<3.5mmol/L,n=100),另有14例患者在住院期间因治疗方案改变先后出现低钾血症和高钾血症,因此未纳入分析。收集并记录人口统计学特征、相关检查和实验室数据。通过电话或门诊的方式随访180天,随访期间记录本研究的主要终点(全因死亡)和次要终点(因HF再入院)。结果:3组患者全因死亡率和因HF再入院率比较均无统计学差异(P>0.05)。本研究中未发现血钾水平与急性HF患者全因死亡率和因HF再入院率间有明显关联;与ACEI/ARB恒量或加量的患者相比,住院期间减量或停用ACEI/ARB的患者发生全因死亡(OR=1.97,95%CI∶1.40~2.75,P<0.001)和因HF再入院(OR=1.73,95%CI∶1.15~2.61,P=0.008)的风险更高。结论:急性HF合并肾功能不全患者住院期间发生高钾血症的风险较高,但患者在不改变或增加RAAS抑制剂剂量的治疗方案中仍可获益。

Objective:To investigate thecorrelation of hyperkalemia and RAAS inhibitor treatment with prognosis in patients with acute heart failure(HF)and renal dysfunction.Methods:A total of 600 patients with acute HF and renal dysfunction admitted to our hospital from January 2017 to August 2021 were enrolled.Patients were assigned into three groups according to their blood potassium levels:(hyperkalemia group(>5.5mmol/L,n=205),normal blood potassium group(3.5~5.5mmol/L,n=281)and hypokalemia group(<3.5mmol/L,n=100).Another 14 patients developed hypokalemia and hyperkalemia during hospitalization and were excluded from this study.Demographic characteristics,relevant examinations and laboratory data were measured and collected during hospitalization.Patients were followed up for approximately 180 days by telephone or outpatient service.Death from all causes was selected as the primary endpoints and readmission due to HF was selected as the secondary endpoint.Results:No statistically difference in the proportion of death from all causes and readmission due to HF among the three groups(P>0.05).In this study,no significant correlation was identifiedbetween blood potassium level and endpoints in patients with acute HF andrenal dysfunction.Compared with patients with constant or increased ACEI/ARB doses,patients who reduced or stopped ACEI/ARB dose during the study had higher proportion for death from all causes(OR=1.97,95%CI:1.40~2.75,P<0.001)and readmission due to heart failure(OR=1.73,95%CI:1.15~2.61,P=0.008).Conclusion:Patients with acute HFand renal dysfunctionhave a higher incidence of hyperkalemia during hospitalization,but patients still benefit from the treatment regimens that do not change or increase the dose of RAAS inhibitors.