The frequency of hyperkalemia and its significance in chronic kidney disease.
The frequency of hyperkalemia and its significance in chronic kidney disease.
复制标题
DOI：
10.1001/archinternmed.2009.132
复制
发表时间：
2009-06-22
影响因子：
--
通讯作者：
Fink, Jeffrey C.
中科院分区：
文献类型：
--
作者：
Einhorn, Lisa M.;Zhan, Min;Hsu, Van Doren;Walker, Lori D.;Moen, Maureen F.;Seliger, Stephen L.;Weir, Matthew R.;Fink, Jeffrey C.
高钾血症是慢性肾病（CKD）患者安全的潜在威胁。这项研究确定了慢性肾脏病高钾血症的发生率以及它是否与死亡率过高有关。这项对2005财政年度期间至少有一次住院和至少一次住院或门诊血清钾记录的245,808名退伍军人的2,103,422份记录的全国队列的回顾性分析。CKD和ACE-I和/或ARB（RAAS阻断剂）治疗是高钾血症的关键预测因素。高钾血症事件发生后1天内死亡是主要结局。在66，529例高钾血症事件（占记录的3.2%）中，住院患者（34937例（52.7%））多于门诊患者（31322例（47.3%））。在接受RAAS阻滞剂治疗的个体中，CKD患者的高钾血症校正发生率高于无CKD患者（7.67 vs. 2.30/100患者月，p<0.0001），而未接受RAAS阻滞剂治疗的个体中，CKD患者的高钾血症校正发生率高于无CKD患者（8.22 vs. 1.77/100患者月，p<0.0001）。调整后的死亡几率（OR）与中度（K+≥ 5.5且< 6.0mg/dl）和重度（K+≥ 6.0 mg/dl）高钾血症事件最高，无慢性肾病（OR：分别为10.32，31.64），与3期（5.35，19.52）、4期（OR：5.73，11.56）或5期CKD（OR：2.31，8.02）相比，所有p<0.0001，与血钾正常且无CKD相比。高钾血症的风险随着CKD而增加，其发生增加了事件发生后一天内死亡的几率。这些发现强调了这种代谢紊乱对CKD患者安全的威胁的重要性。
Hyperkalemia is a potential threat to patient safety in chronic kidney disease (CKD). This study determined the incidence of hyperkalemia in CKD and whether it is associated with excess mortality. This retrospective analysis of a national cohort comprised of 2,103,422 records from 245,808 veterans with at least one hospitalization and at least one inpatient or outpatient serum potassium record during fiscal year 2005. CKD and treatment with ACE-I and/or ARBs (RAAS blockers) were the key predictors of hyperkalemia. Death within one day of a hyperkalemic event was the principal outcome. Of the 66,529 hyperkalemic events (3.2% of records), more occurred inpatient (34937 (52.7%)) versus outpatient (31322 (47.3%)). The adjusted rate of hyperkalemia was higher in patients with CKD than without CKD among individuals treated with RAAS blockers (7.67 vs. 2.30 per 100 patient months, p<0.0001) and those without RAAS blocker treatment (8.22 vs. 1.77 per 100 patient months, p<0.0001). The adjusted odds (OR) of death with a moderate (K+≥ 5.5 and < 6.0mg/dl) and severe (K+≥ 6.0 mg/dl) hyperkalemic event was highest with no CKD (OR: 10.32, 31.64, respectively), versus Stage 3 (5.35, 19.52), Stage 4 (OR: 5.73, 11.56), or Stage 5 CKD (OR: 2.31, 8.02) with all p<0.0001 versus normokalemia and no CKD. The risk of hyperkalemia is increased with CKD, and its occurrence increases the odds of mortality within one day of the event. These findings underscore the importance of this metabolic disturbance as a threat to patient safety in CKD.
登录
查看更多内容
影响因子：
--
作者：
Acker, CG;Johnson, JP;Greenberg, A
通讯作者：
Greenberg, A
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
19.6
作者：
Gennari, FJ;Segal, AS
通讯作者：
Segal, AS
影响因子：
--
作者：
MALNIC, G;KLOSE, RM;GIEBISCH, G
通讯作者：
GIEBISCH, G
影响因子：
120.7
作者：
Coresh, Josef;Selvin, Elizabeth;Levey, Andrew S.
通讯作者：
Levey, Andrew S.