慢性肾脏疾病患者血钾异常的影响因素及对预后的影响研究  

Study on influencing factors and prognosis of abnormal blood potassium in patients with chronic kidney disease

作　　者：张灿[1] 王静[1] ZHANG Can;WANG Jing(Department of Lung Transplantation/Gastrintestinal Surgery,The First Afiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肺移植外科/胃肠外科三病区,郑州450052

出　　处：《医药论坛杂志》2022年第13期20-23,共4页Journal of Medical Forum

基　　金：2020年河南省医学科技攻关计划项目(LHGJ20201257)。

摘　　要：目的探讨慢性肾脏疾病(chronic kidney disease,CKD)患者血钾异常的影响因素及对其预后的影响。方法对2020年4月—2021年5月郑州大学第一附属医院收治的300例CKD患者的临床资料进行回顾性分析。收集患者的一般资料(性别、年龄、BMI指数、是否合并高血压、糖尿病、用药情况、CKD分期等)、实验室指标(K^(+)、Scr、BUN、UCr、ALB),按照K^(+)水平将300例CKD患者分为高血钾症组(K^(+)≥5.5 mmol/L,n=13)、正常组(3.5 mmol/L≤K^(+)<5.5 mmol/L,n=272)、低血钾症组(K^(+)<3.5 mmol/L,n=15)。对3组进行为期1年的随访,评估3组预后情况(终末期肾脏病、心血管疾病事件发生率、死亡率)。通过多因素logistic回归分析影响CKD患者血钾异常的因素。结果3组在高血压、嗪类或袢利尿剂使用比例、CKD分期以及BUN、Scr、UACR、eGFR水平方面比较差异有统计学意义(P<0.05);进行多因素logistic回归分析,结果显示,使用嗪类或袢利尿剂(P=0.025,OR=6.334)、BUN(P=0.022,OR=10.085)、Scr(P=0.020,OR=4.668)、eGFR(P=0.017,OR=5.686)是CKD患者血钾异常影响因素;3组的预后情况在统计学比较中差异无统计学意义(P>0.05),但低血钾症组死亡率最高(13.33%),且高血钾症组终末期肾脏病、心血管疾病事件发生率(23.07%、15.38%)最高。结论使用噻嗪类或袢利尿剂、BUN、Scr、eGFR是影响CKD患者血钾异常的因素,且低血钾会增加CKD患者的死亡风险。应对相关危险因素进行控制并给予有效措施,从而改善CKD患者的血钾水平和预后。Objective To investigate the influencing factors and prognosis of abnormal blood potassium in patients with chronic kidney disease(CKD).Methods The clinical data of 300 patients with CKD admitted to our hospital from April 2020 to May 2021 were retrospectively analyzed.General information(gender,age,BMI,hypertension,diabetes,medication,CKD stage,etc.)and laboratory indicators(K,Scr,BUN,UCr,ALB)were collected,and 300 CKD patients were divided into hyperkalemia group(K^(+)≥5.5 mmol/L,n=13),normal group(3.5 mmol/L≤K^(+)<5.5 mmol/L,n=272),hypokalemia group(K^(+)<3.5 mmol/L,n=15).The three groups were followed up for a period of 1 year to evaluate the outcomes of the three groups(end-stage renal disease,incidence of cardiovascular disease events,mortality).Multivariate logistic regression was used to analyze the factors affecting abnormal serum potassium in patients with CKD.Results There were significant differences among the three groups in hypertension,the proportion of azine or loop diuretic,CKD stage and BUN,Scr,UACR and eGFR levels(P<0.05).Multivariate logistic regression analysis showed that azines OR Loop diuretics(P=0.025,OR=6.334),BUN(P=0.022,OR=10.085),Scr(P=0.020,OR=4.668),eGFR(P=0.017,OR=5.686)was an influential factor of abnormal serum potassium in CKD patients.There was no significant difference in prognosis among the three groups(P>0.05),but the mortality rate was the highest in the hypokalemia group(13.33%),and the incidence of end-stage renal disease and cardiovascular disease events was the highest in the hyperkalemia group(23.07%,15.38%).Conclusion The use of thiazide or loop diuretics,BUN,Scr,eGFR are the factors affecting abnormal blood potassium in patients with CKD,and low blood potassium will increase the risk of death in patients with CKD.Relevant risk factors should be controlled and effective measures should be taken to improve serum potassium level and prognosis of patients with CKD.

关 键 词：慢性肾脏病 高血钾症 低血钾症 影响因素 预后 

分 类 号：R692[医药卫生—泌尿科学]