维持性血液透析患者反复高钾及严重高钾血症的相关因素分析

Related factors for recurrent hyperkalemia and severe hyperkalemia in maintenance hemodialysis patients

目的探讨维持血液透析(MHD)患者高钾血症、反复高钾血症及严重高钾血症(血钾>6mmol/L)的患病率,并分析相关因素。方法回顾性分析2022年1月1日~2022年12月30日在浙江省杭州市中医院血液净化中心规律血透患者的临床资料。根据峰值血钾水平分为非高钾组和高钾组;高钾患者中根据高钾次数是否≥2次分为反复高钾组和单次高钾组,以峰值血钾是否>6.0mmol/L分为严重高钾组和非严重高钾组,调查不同血钾异常的患病率并分析相关因素。结果共纳入458例患者,非高钾组189例(41.3%),高钾组269例(58.7%)。多因素Logistic回归分析结果显示,合并心功能不全、增重多、使用肾素-血管紧张素-醛固酮系统抑制剂(RAASi)、血透前血尿素、高甲状旁腺素、高血磷、低甘油三酯为高钾血症的独立相关因素(P<0.05)。在269例高钾血症患者中,单次高钾组99例(36.8%),反复高钾组170例(63.2%),多因素Logistic回归分析结果显示,增重多(OR=1.918,95%CI:1.038—3.546,P=0.038)和严重高钾血症(OR=9.422,95%CI:4.061—21.863,P<0.01)为反复高钾血症的独立相关因素;非严重高钾血症189例(70.3%),严重高钾血症80例(29.3%),多因素Logistic回归分析结果显示,低血尿酸(OR=0.996,95%CI:0.993—0.999,P=0.041)为严重高钾血症的独立相关因素。结论高钾血症在MHD患者中高发、易反复发作且出现严重高钾血症,对于合并心功能不全、增重多、服用RAASi、甲状旁腺素高、血磷高、血透前血尿素水平高的患者,应定期复查血钾;对于增重多及严重高钾血症患者,应加强血钾监测,及时处理并控制血钾。

Objective To investigate the prevalence of hyperkalemia,recurrent hyperkalemia and severe hyperkalemia(serum potassium>6mmol/L)in maintenance hemodialysis patients,and analyze the related factors.Methods Thegeneral information and clinical data of maintenance hemodialysis patients in the hemodialysis center of Hangzhou Hospital of Traditional Chinese Medicine,Zhejiang Province,from January 1,2022,to December 30,2022,were collected.According to the level of the peak value of serum potassium,the patients were divided into a non-hyperkalemia group and a hyperkalemia group.Patients in the hyperkalemia group were further divided into a single hyperkalemia group and a recurrent hyperkalemia group according to whether the number of occurrences of hyperkalemia was greater than or equal to 2 times,and were divided into severe hyperkalemia group and non-severe hyperkalemia group according to whether the peak value of serum potassium was greater than or equal to 6.0mmol/L.Then,the prevalence of different serum potassium abnormalities and the related factors were explored.Results A total of 458 patients.Among these patients,189 cases(41.3%)were in the non-hyperkalemia group and 269 cases(58.7%)were in the hyperkalemia group.Multivariate logistic regression analysis demonstrated that concurrent cardiac insufficiency,excessive weight gain,usage of renin-angiotensin-aldosterone system in hibitors(RAASi),high levels of serum urea,parathyroid hormone and phosphorus,and low serum triglyceride were independent risk factors for hyperkalemia.Among the 269 patients with hyperkalemia,99 cases(36.8%)were in the single hyperkalemia group and 170 cases(63.2%)were in recurrent hyperkalemia group.Multivariate logistic regression analysis demonstrated that excessive weight gain(OR=1.918,95%CI:1.038—3.546,P=0.038)and severe hyperkalemia(OR=9.422,95%CI:4.061—21.863,P<0.01)were independent risk factors for the recurrence of hyperkalemia.Among the 269 patients with hyperkalemia,189 cases(70.3%)were in the non-severe hyperkalemia group and 80 cases(29.3%)were in severe hyperkalemia group.Multivariate logistic regression analysis demonstrated that low levels of serum uric acid(OR=0.996,95%CI:0.993—0.999,P=0.041)were independent risk factors for severe hyperkalemia.Conclusion The prevalence of hyperkalemia in MHD patients is high,prone to recurrent attacks and severe hyperkalemia.It is necessary to monitor serum potassium regularly for patients with cardiac insufficiency,excessive weight gain,usage of RAASi or high levels of serum urea,parathyroid hormone or phosphorus.For patients with excessive weight gain and severe hyperkalemia,monitoring of serum potassium should be strengthened to be timely treated and controlled to a normal level.