Lactated Ringer's solution and risk of hyperkalemia in patients with reduced kidney function.
Lactated Ringer's solution and risk of hyperkalemia in patients with reduced kidney function.
复制标题
乳酸林格氏液和肾功能下降患者高钾血症的风险。
DOI：
10.1016/j.amjms.2022.04.024
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发表时间：
2022-10
影响因子：
3.1
通讯作者：
Zarjou, Abolfazl
中科院分区：
文献类型：
--
作者：
Rajasekaran, Arun;Bade, Naveen;Cutter, Gary R.;V. Rizk, Dana;Zarjou, Abolfazl
新出现的证据支持平衡晶体如乳酸林格氏液（LR）与生理盐水相比的优越性，但对高钾血症发展的担忧限制了其使用。虽然LR本身含有钾，但缺乏证据表明LR可增强高钾血症。为了解决这一问题，我们评估了LR对肾功能减退且有发生高钾血症风险的患者血清钾的影响。我们进行了一项单中心、基于队列的回顾性观察性临床研究，纳入了293例住院的临床病例，入院时估计肾小球滤过率（eGFR）< 30 ml/min/1.73 m2。受试者必须在入院期间连续接受至少500 ml LR。仅纳入在LR给药前和给药后24小时内至少有一份实验室报告报告钾、葡萄糖和碳酸氢盐水平血清测量值的受试者。记录发生高钾血症的其他潜在风险因素，包括LR给药期间或给药后24小时内的药物、管饲、钾补充剂和红细胞输注。LR使用前的血清钾与LR使用后的血清钾高度相关和预测[P < 0.0001;比值比6.77（3.73 - 12.28）]。16例患者（5%）在使用LR后发生了新发高钾血症。LR给药量与高钾血症的发生之间无显著正相关，LR使用与肾功能减退患者高钾血症的发生无独立相关性。
Emerging evidence supports the superiority of balanced crystalloids such as Lactated Ringer’s (LR) compared to normal saline but concerns for the development of hyperkalemia have limited its use. Although LR inherently contains potassium, there exists a paucity of evidence to suggest that LR could potentiate hyperkalemia. To address this, we evaluated the effect of LR on serum potassium in patients with reduced kidney function who are at risk of developing hyperkalemia. We conducted a single-center, retrospective cohort-based observational clinical study that included 293 clinical encounters who were hospitalized with an estimated glomerular filtration rate (eGFR) of < 30 ml/min/1.73m2, at the time of hospital admission. Subjects must have received a minimum of 500 ml of LR continuously during the admission. Only those with a minimum of one lab report within 24 hours prior to-, and post-LR administration that reported serum measurements of potassium, glucose, and bicarbonate levels were included. Other potential risk factors for developing hyperkalemia including medication, tube feeds, potassium supplements, and red blood cell transfusion during or within 24 hours after LR administration were recorded. Serum potassium prior to LR use was highly correlated and predictive of the serum potassium after LR use [P < 0.0001; Odds Ratio 6.77 (3.73 – 12.28)]. Sixteen encounters (5%) developed de-novo hyperkalemia following LR use. No significant positive correlation between the amount of LR administered and the development of hyperkalemia was found. LR use was not independently associated with the development of hyperkalemia in patients with reduced kidney function.
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DOI：
10.2215/cjn.08580813
发表时间：
2015-06-01
影响因子：
9.8
作者：
Palmer, Biff F.
通讯作者：
Palmer, Biff F.
影响因子：
8.8
作者：
Raghunathan, Karthik;Shaw, Andrew;Lindenauer, Peter K.
通讯作者：
Lindenauer, Peter K.
影响因子：
2.5
作者：
PEREZ, GO;OSTER, JR;VAAMONDE, CA
通讯作者：
VAAMONDE, CA
影响因子：
1.5
作者：
Zitek, Tony;Skaggs, Zachary D.;Khan, Memona
通讯作者：
Khan, Memona
DOI：
10.1056/nejmoa1711586
发表时间：
2018-03-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Self WH;Semler MW;Wanderer JP;Wang L;Byrne DW;Collins SP;Slovis CM;Lindsell CJ;Ehrenfeld JM;Siew ED;Shaw AD;Bernard GR;Rice TW;SALT-ED Investigators
通讯作者：
SALT-ED Investigators