老年慢性收缩功能降低的心力衰竭患者血钾水平变异性与肾功能不全风险的相关性

Correlation between variability of serum potassium level and risk of renal insufficiency in elderly patients with chronic systolic heart failure

目的探讨老年慢性收缩功能降低的心力衰竭患者血钾水平变异性与肾功能不全风险的相关性。方法连续纳入2020年1月至2022年11月芜湖市第一人民医院心血管内科收治的老年慢性心力衰竭患者157例,根据是否发生肾功能不全分为发生组36例和未发生组121例。收集所有患者一般资料,并随访6个月,记录分析血钾变异性,采用多因素logistic回归分析血钾变异性与老年慢性心力衰竭患者肾功能不全的相关性。结果发生组血钾变化幅度、血钾最大波动的速率、血钾变异系数显著高于未发生组(P<0.01)。多因素logistic回归分析显示,住院时间(OR=1.174,95%CI:1.067~1.292,P=0.001)、年龄(OR=1.939,95%CI:1.309~2.872,P=0.001)、白蛋白(OR=0.866,95%CI:0.751~0.997,P=0.046)、血钾变化幅度(OR=1.774,95%CI:1.519~2.071,P=0.016)、血钾最大波动的速率(OR=1.631,95%CI:1.265~2.167,P=0.001)、血钾变异系数(OR=1.670,95%CI:1.212~2.230,P=0.002)是老年慢性心力衰竭患者肾功能不全发生的独立影响因素。logistic回归分析显示,血钾变化幅度≥0.80、血钾最大波动的速率≥0.40、血钾变异系数≥8.20与老年慢性心力衰竭患者肾功能不全发生显著相关(P<0.01)。结论血钾水平的高变异性是老年慢性心力衰竭患者肾功能不全发生风险的危险因素。

Objective To explore the correlation between the variability of blood potassium level and risk of renal insufficiency(RI)in elderly heart failure(HF)patients with chronic systolic dysfunction.Methods A total of 157 consecutive elderly patients with chronic HF admitted in Department of Cardiovascular Medicine of Wuhu First People's Hospital from January 2020 to November 2022 were included,and according to whether RI occurred or not,they were divided into the RI group(36 cases)and the non-RI group(121 cases).Their general data and blood potassium variability was collected and recorded,and all of them were followed up for 6 months.Multivariate logistic regression analysis was applied for the correlation between blood potassium variability and RI in the elderly patients with chronic HF.Results The range of change,maximum fluctuation rate and coefficient of variation for blood potassium were significantly higher in the RI group than the non-RI group(P<0.01).Multivariate logistic regression analysis showed that length of hospital stay(OR=1.174,95%CI:1.067-1.292,P=0.001),age(OR=1.939,95%CI:1.309-2.872,P=0.001),albumin level(OR=0.866,95%CI:0.751-0.997,P=0.046),and range of change(OR=1.774,95%CI:1.519-2.071,P=0.016),maximum fluctuation rate(OR=1.631,95%CI:1.265-2.167,P=0.001)and coefficient of variation of blood potassium(OR=1.670,95%CI:1.212-2.230,P=0.002)were independent influencing factor for RI in the patients.Logistic regression analysis indicated that the range of serum potassium change≥0.80,the maximum fluctuation rate≥0.40,and the coefficient of variation of serum potassium≥8.20 were closely correlated with RI in elderly patients with chronic HF(P<0.01).Conclusion High variability of blood potassium level is a risk factor for RI in elderly patients with chronic HF.