Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology
Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology
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DOI：
10.1007/s40620-019-00617-y
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发表时间：
2019-08-01
影响因子：
3.4
通讯作者：
Regolisti, Giuseppe
中科院分区：
文献类型：
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作者：
Bianchi, Stefano;Aucella, Filippo;Regolisti, Giuseppe
高钾血症(HK)是肾脏疾病患者最常见的电解质紊乱，尤其是在糖尿病和心力衰竭患者或正在接受肾素-血管紧张素-醛固酮系统抑制剂(RAASI)治疗的患者中。香港被认为是潜在危及生命的心律失常并发症的主要风险。当慢性肾脏病(CKD)患者和肾功能正常的患者出现急性肾功能减退时，HK是进行紧急治疗和求助于体外替代疗法的主要指征。在终末期肾病患者中，HK对药物治疗无反应是慢性肾脏替代治疗开始时的一个指征。HK也可能与CKD的进展间接相关，因为发现高钾值会导致RAASIs停止治疗，RAASIs构成了首选的肾脏保护治疗。因此，有必要识别有可能发展为香港的患者，并实施旨在预防和治疗这种危险的肾脏疾病并发症的治疗干预措施。目前旨在预防和治疗香港的策略仍然不令人满意，证明香港的发病率相对较高，在接受稳定肾病护理的患者中也是如此，甚至在必须进行最佳治疗和监测的理想随机临床试验环境中也是如此。这份立场文件将综述为预防、检测和治疗慢性肾脏病患者而实施的主要治疗干预措施，这些患者包括接受保守治疗的CKD患者、透析患者、肾脏疾病与糖尿病、心力衰竭、顽固性高血压相关的患者以及正在接受RAASIs治疗的患者，最后是出现严重急性香港患者。
Hyperkalemia (HK) is the most common electrolyte disturbance observed in patients with kidney disease, particularly in those in whom diabetes and heart failure are present or are on treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs). HK is recognised as a major risk of potentially life threatening cardiac arrhythmic complications. When an acute reduction of renal function manifests, both in patients with chronic kidney disease (CKD) and in those with previously normal renal function, HK is the main indication for the execution of urgent medical treatment and the recourse to extracorporeal replacement therapies. In patients with end-stage renal disease, the presence of HK not responsive to medical therapy is an indication at the beginning of chronic renal replacement therapy. HK can also be associated indirectly with the progression of CKD, because the finding of high potassium values leads to withdrawal of treatment with RAASIs, which constitute the first choice nephro-protective treatment. It is therefore essential to identify patients at risk of developing HK, and to implement therapeutic interventions aimed at preventing and treating this dangerous complication of kidney disease. Current strategies aimed at the prevention and treatment of HK are still unsatisfactory, as evidenced by the relatively high prevalence of HK also in patients under stable nephrology care, and even in the ideal setting of randomized clinical trials where optimal treatment and monitoring are mandatory. This position paper will review the main therapeutic interventions to be implemented for the prevention, detection and treatment of HK in patients with CKD on conservative care, in those on dialysis, in patients in whom renal disease is associated with diabetes, heart failure, resistant hypertension and who are on treatment with RAASIs, and finally in those presenting with severe acute HK.