维持性血液透析患者血钾水平及其对预后影响

Serum potassium level in maintenance hemodialysis patients and its effect on outcome

维持性血液透析是终末期肾病患者肾脏替代治疗的方式之一,血钾异常是维持性血液透析患者常见的代谢并发症,透析前高钾血症、透析期间和透析后低钾血症均可能与维持性血透患者全因死亡、心血管事件死亡有关。目前,血钾波动对患者预后的影响受到广泛关注,因维持性血液透析的间歇性治疗特点,患者经历更频繁的血钾波动,血钾变异性能较好地反映患者血钾稳态情况,血钾变异性大是维持性血液透析患者不良预后的潜在危险因素。此外,透析过程中患者血钾水平的急性变化易增加患者恶性心律失常、心源性猝死和其他不良预后的发生风险。血清-透析液钾浓度梯度是影响钾清除的重要因素,其他透析液成分同样影响血钾清除。因此,加强患者血钾水平的监测和管理,选择适宜的透析液钾浓度,个体化制定透析处方有利于维持性血液透析患者维持钾稳态,减少血钾异常发生,改善预后。该文简要阐述维持性血液透析患者血钾水平的变化特点,讨论维持性血液透析患者血钾水平对预后的影响,强调血钾变异与患者预后的关系以及透析液成分对血钾水平稳定的影响。

Maintenance hemodialysis is one of the renal replacement therapy that end-stage renal disease patients mainly rely on.Dyskalemia is one of the most common metabolic complications in patients undergoing maintenance hemodialysis.Both predialysis hyperkalemia and hypokalemia during and after dialysis may contribute to a higher risk of all-cause mortality,cardiovascular mortality in hemodialysis patients.The impact of serum potassium fluctuation has attracted widespread attention in recent years.Due to the intermittent nature of maintenance hemodialysis,patients are prone to frequent fluctuations of serum potassium.Potassium variability may be a better indicator to reflect potassium homeostasis,and large variability of potassiun is recognized as a potential risk factor for poor outcomes.In addition,the rapid fluctuation of serum potassium concentration during hemodialysis may increase the risk of malignant arrhythmia,sudden cardiac death and other poor outcomes.The gradient of serum and dialysate potassium is an important factor that influence the removal of potassium,which is also affected by other dialysate components.Therefore,strengthening the monitoring and management of serum potassium,selecting appropriate dialysate potassium concentration and individualizing dialysate prescription may be beneficial to maintain potassium homeostasis,reduce dyskalemia and improve prognosis.This review briefly expounds the feature of serum potassium level and discusses its effect on outcomes in patients with maintenance hemodialysis,emphasizing the relevance of potassium variation and prognosis in patients with maintenance hemodialysis and the impact of dialysate composition on potassium homeostasis.