Electrolyte Disorders in Community Subjects: Prevalence and Risk Factors
Electrolyte Disorders in Community Subjects: Prevalence and Risk Factors
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DOI：
10.1016/j.amjmed.2012.06.037
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发表时间：
2013-03-01
影响因子：
5.9
通讯作者：
Hoorn, Ewout J.
中科院分区：
文献类型：
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作者：
Liamis, George;Rodenburg, Eline M.;Hoorn, Ewout J.
背景：电解质紊乱主要在住院患者中进行了研究，而普通人群中的相关数据有限。本研究的目的是确定从普通人群中招募的老年受试者中常见电解质紊乱的患病率和危险因素。
方法：从基于人群的鹿特丹研究中纳入了共5179名55岁及以上的受试者。我们重点关注低钠血症、高钠血症、低钾血症、高钾血症和低镁血症。采用多变量逻辑回归研究与肾功能、合并症和药物的潜在关联。还确定了每种电解质紊乱的校正死亡率。
结果：共有776名受试者（15.0%）至少有一种电解质紊乱，其中低钠血症（7.7%）和高钠血症（3.4%）最为常见。糖尿病被确定为低钠血症和低镁血症的独立危险因素，而高血压与低钾血症相关。利尿剂与几种电解质紊乱独立相关：噻嗪类利尿剂（低钠血症、低钾血症、低镁血症）、袢利尿剂（高钠血症、低钾血症）和保钾利尿剂（低钠血症）。苯二氮䓬类药物的使用也与低钠血症相关。同时使用噻嗪类和苯二氮䓬类药物的低钠血症受试者的血清钠浓度比使用其中一种或不使用这些药物的受试者低3 mmol/L（P <.001）。低钠血症和低镁血症与死亡风险增加独立相关。
结论：电解质紊乱在老年社区受试者中很常见，主要与糖尿病和利尿剂相关。同时使用噻嗪类和苯二氮䓬类药物的受试者低钠血症程度更严重。由于即使是轻度的电解质紊乱也与死亡率相关，监测电解质并停用相关有害药物可能会改善预后。（C）2013爱思唯尔公司。保留所有权利。《美国医学杂志》（2013年）126卷，256 - 263页
BACKGROUND: Electrolyte disorders have been studied mainly in hospitalized patients, whereas data in the general population are limited. The aim of this study was to determine the prevalence and risk factors of common electrolyte disorders in older subjects recruited from the general population.METHODS: A total of 5179 subjects aged 55 years or more were included from the population-based Rotterdam Study. We focused on hyponatremia, hypernatremia, hypokalemia, hyperkalemia, and hypomagnesemia. Multivariable logistic regression was used to study potential associations with renal function, comorbidity, and medication. The adjusted mortality also was determined for each electrolyte disorder.RESULTS: A total of 776 subjects (15.0%) had at least 1 electrolyte disorder, with hyponatremia (7.7%) and hypernatremia (3.4%) being most common. Diabetes mellitus was identified as an independent risk factor for hyponatremia and hypomagnesemia, whereas hypertension was associated with hypokalemia. Diuretics were independently associated with several electrolyte disorders: thiazide diuretics (hyponatremia, hypokalemia, hypomagnesemia), loop diuretics (hypernatremia, hypokalemia), and potassium-sparing diuretics (hyponatremia). The use of benzodiazepines also was associated with hyponatremia. Hyponatremic subjects who used both thiazides and benzodiazepines had a 3 mmol/L lower serum sodium concentration than subjects using 1 or none of these drugs (P < .001). Hyponatremia and hypomagnesemia were independently associated with an increased mortality risk.CONCLUSIONS: Electrolyte disorders are common among older community subjects and mainly associated with diabetes mellitus and diuretics. Subjects who used both thiazides and benzodiazepines had a more severe degree of hyponatremia. Because even mild electrolyte disorders were associated with mortality, monitoring of electrolytes and discontinuation of offending drugs may improve outcomes. (C) 2013 Elsevier Inc. All rights reserved. The American Journal of Medicine (2013) 126, 256-263