终末期肾病患者初次腹膜透析低钾发生率及危险因素分析  

Risk factors for the incidence of hypokalemia among end-stage renal disease patients undergoing primary peritoneal dialysis

作　　者：蒋静[1] 钟慧[1] 付平[1] JIANG Jing;ZHONG Hui;FU Ping(Department of Nephrology,West China Hospital,Sichuan 610041,China)

机构地区：[1]四川大学华西肾脏病研究室,成都610041

出　　处：《中国血液净化》2019年第4期230-233,共4页Chinese Journal of Blood Purification

基　　金：四川省科技厅-支撑计划(2017FZ0092)

摘　　要：目的探讨初次行持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)的终末期肾病(end-stage renal disease,ESRD)患者低钾的发生率及影响因素。方法收集2011年1月～2016年10月在四川大学华西医院肾脏内科初次行腹膜透析(peritoneal dialysis, PD)置管的350例CAPD患者的临床数据。根据术后初次血钾水平分为低钾组(<3.5mmol/L)和非低钾组(≥3.5mmol/L)。结果低钾组65例(18.57%),与非低钾组相比,血清白蛋白(Z=-3.695,P<0.001)、尿量(Z=-3.413,P=0.001)水平较低,而年龄(χ~2=7.627,P=0.006)、白细胞介素-6(Z=-2.832,P=0.005)、Kt/V(Z=-2.543,P=0.011)、4h透析液与血肌酐比值(D/P Cr(4h))(Z=-2.686,P=0.007)偏高。2组间性别(χ~2=0.357,P=0.550)、血红蛋白(Z=-0.031,P=0.975)、超滤量(Z=-1.105,P=0.269)、透析龄(Z=-0.041,P=0.967)差异均无统计学意义。相关分析显示:血钾水平与血清白蛋白(r=0.185,P<0.001)、尿量(r=0.136,P=0.011)呈正相关,与年龄(r=-0.142,P=0.008)、D/P Cr(4h)(r=-0.185,P=0.001)、透析Kt/V(r=-0.188,P<0.001)呈负相关。逐步多元线性回归分析显示:年龄(β=-0.006,P=0.011)、血清白蛋白(β=0.017,P=0.013)、每周总Kt/V(β=-0.181,P=0.005)、二氧化碳结合力(β=-0.061,P<0.001)、尿量(β=0,P=0.016)是低血钾的危险因素。结论初次腹膜透析的ESRD患者低钾发生率较高;应关注初次腹膜透析患者的血钾情况,尤其是老年及营养不良者。Objectives T o evaluate the incidence of hypokalemia and the factors associated with hypokalemia among patients with primary continuous ambulatory peritoneal dialysis(CAPD).Methods Clinical data of the 350 eligible CAPD patients undergoing peritoneal catheter placement in West China Hospital of Sichuan university from January 2011 to November 2016 were collected.The patients were divided into hy-pokalemia group(<3.5mmol/L)and non-hypokalemia group(≥3.5mmol/L)based on the first serum potassium level.Results Hypokalemia group included 65 cases(18.57%).Serum albumin(Z=-3.695,P<0.001),urine volume(Z=-3.413,P=0.001)were lower in hypokalemia group than in non-hypokalemia group.In contrast,age(χ^2=7.627,P=0.006),serum IL-6(Z=-2.832,P=0.005),dialysate Kt/V(Z=-2.543,P=0.011),4-hour dialysate to plasma creatinine ratio(Z=-2.686,P=0.007)were higher in hypokalemia group than in non-hypokalemia group.There were no significant differences in gender(χ^2=0.357,P=0.550),hemoglobin(Z=-0.031,P=0.975),ultrafiltration capacity(Z=-1.105,P=0.269)and duration of CAPD(Z=-0.041,P=0.967)between the two groups.Pearson correlation analysis showed that serum potassium level correlated positively with serum albumin(r=0.185,P<0.001),urine volume(r=0.036,P=0.011);and negatively with age(r=-0.142,P=0.008),D/P Cr(4h)(r=-0.185,P=0.001)and dialysate Kt/V(r=-0.188,P<0.001).Multivariate stepwise linear regression analysis revealed that age(β=-0.006,P=0.011),serum albumin(β=0.017,P=0.013),total Kt/V(β=-0.181,P=0.005),CO2CP(β=-0.061,P<0.001)and urine volume(β=0,P=0.016)were the risk factors for hypokalemia.Conclusion A higher incidence of hypokalemia is observed in primary CAPD patients.We should pay attention to serum potassium in PD patients,especially in senile and poor nutrition patients.

关 键 词：腹膜透析 低钾血症 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]