中国透析患者高钾血症现状分析  

Current status of hyperkalemia in dialysis patients in China

作　　者：黄娜娅 刘苑莹 余健文 许元文[1] 郑勋华[1] 张涤华[1] 艾珍[1] 吴海珊 刁翔文[1] 叶晓青[1] 易春燕[1] 毛海萍[1] 阳晓[1] 余学清[1,2] 陈崴 Huang Naya;Liu Yuanying;Yu Jianwen;Xu Yuanwen;Zheng Xunhua;Zhang Dihua;Ai Zhen;Wu Haishan;Diao Xiangwen;Ye Xiaoqing;Yi Chunyan;Mao Haiping;Yang Xiao;Yu Xueqing;Chen Wei(Department of Nephrology,the First Affiliated Hospital of Sun Yat-sen University/Key Laboratory of Nephrology,National Health Commission/Guangdong Provincial Key Laboratory of Nephrology,Guangzhou 510080,China;Department of Nephrology,Guangdong Provincial Peopled Hospital,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院肾内科,国家卫生健康委员会肾脏病临床研究重点实验室,广东省肾脏病重点实验室,广州510080 [2]广东省人民医院肾内科,广东医学科学院,广州510080

出　　处：《中华医学杂志》2021年第42期3466-3471,共6页National Medical Journal of China

基　　金：国家重点研发项目(2016YFC0906100,2017YFC0907603);国家自然科学基金(81970599);广州市科技计划(201804020049);广东省重点实验室运行经费(2002B60118,2020B1212060028)。

摘　　要：目的探讨透析患者高钾血症的发生率及其相关因素。方法纳入2017年1月至2019年12月全国多中心血液透析(HD)和腹膜透析(PD)数据库登记的年龄≥18岁,透析时间≥3个月的患者,分析高钾血症发生率及其相关因素。结果共纳入12364例患者,男6836例,年龄(51±15)岁,HD 4230例,PD 8134例,高钾血症发生率20.7%(2554/12364),低钾血症发生率17.0%(2102/12364)。多因素logistic回归分析结果显示,高钾血症的独立相关因素包括HD(OR=2.25,95%CI:1.54~3.30)、糖尿病(OR=1.65,95%CI:1.17~2.32)、高体质指数(BMI)(OR=1.06,95%CI:1.03~1.09)、高白蛋白(OR=1.04,95%CI:1.01~1.07)、高血磷(OR=3.12,95%CI:2.44~4.00)、低二氧化碳结合力(OR=0.89,95%CI:0.87~0.92)、低三酰甘油(OR=0.76,95%CI:0.68~0.85)、低血肌酐水平(OR=0.95,95%CI:0.90~0.99)、使用血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)(OR=1.38,95%CI:1.11~1.72)及β-受体阻滞剂(OR=1.32,95%CI:1.07~1.64)。结论我国透析患者高钾血症发生率为20.7%,HD、糖尿病、高BMI、高白蛋白、高血磷、低二氧化碳结合力、低三酰甘油、低血肌酐水平、使用ACEI/ARB及β-受体阻滞剂是其独立相关因素。Objective To investigate the prevalence and associated factors of hyperkalemia in dialysis patients.Methods Patients underwent hemodialysis(HD)and peritoneal dialysis(PD)from multi-center databases were recruited from January 2017 to December 2019,and those aged≥18 years and with dialysis duration≥3 months were included to analyze the prevalence and related factors of hyperkalemia.Results A total of 12364 patients were enrolled in the study,and 6836 cases were men.The average age of the patients was(51±15)years.Among these patients,4230 cases underwent HD while 8134 received PD.Hyperkalemia was detected in 20.7%(2554/12364)of the patients while hypokalemia was found in 17.0%(2102/12364)of the patients.Multivariate logistic regression showed that HD(OR=2.25,95%CI:1.54-3.30),diabetes mellitus(DM)(OR=1.65,95%CI:1.17-2.32),high body mass index(BMI)(OR=1.06,95%CI:1.03-1.09),high levels of serum albumin(OR=1.04,95%CI:1.01-1.07)and phosphorus(OR=3.12,95%CI:2.44-4.00),low levels of serum bicarbonate(OR=0.89,95%CI:0.87-0.92),triglycerides(OR=0.76,95%CI:0.68-0.85)and creatinine(OR=0.95,95%CI:0.90-0.99),usage of angiotensin converting enzyme inhibitor/AngiotensinⅡreceptor antagonist(ACEI/ARB,OR=1.38,95%CI:1.11-1.72)and beta-blocker(OR=1.32,95%CI:1.07-1.64)were associated with hyperkalemia.Conclusions Hyperkalemia occurred in 20.7%of the dialysis patients.HD,DM,high BMI,high levels of serum albumin and phosphorus,low levels of serum bicarbonate,triglycerides and creatinine,use of ACEI/ARB were associated with hyperkalemia.

关 键 词：高钾血症 血液透析 腹膜透析 横断面研究 

分 类 号：R692.5[医药卫生—泌尿科学] R589.4[医药卫生—外科学]