The Correlation between Angiotensin Ⅱ Receptor Blockers and Hyperkalemia in Hemodialysis Patients_West China Medical Journal

Authors：

CHEN Xiaolei

1. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China; 2. Department of Nephrology, First People′s Hospital of Longquanyi District, Chengdu, Sichuan 610100, P. R. China;

Corresponding author：

Keywords：

血管紧张素受体拮抗剂; 血液透析; 高钾血症

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【摘要】　目的　血管紧张素受体拮抗剂（angiotension Ⅱ receptor blockers，ARB）是血液透析患者常用的降压药物之一，可对肾脏的排钾功能产生影响。研究通过对血液透析患者高钾血症的发生情况进行调查，了解并分析相关影响因素，探讨ARB类药物在血液透析患者中应用的安全性。　方法　 2010年1月－2010年7月对95例维持性血液透析患者的临床资料进行调查，比较ARB组和非ARB组高钾血症的发生率，并将可能的危险因素和高钾血症的发生率进行相关性分析。　结果　纳入患者中使用ARB类降压药47例，未使用ARB类降压药48例。ARB组高钾血症15例（31.9%），非ARB组高钾血症14例（29.2%），发生率无统计学意义（P gt;0.05）。将高钾患者和血钾正常患者做对比，高钾血症组年龄较轻[（47.69±13.64）岁，（54.50±13.54）岁；P lt;0.05]，尿量 lt;400 mL者所占比例更大（89.7%，57.6%；P lt;0.05）。logistic回归分析结果显示，高钾血症的发生与年龄、透析次数、尿量相关，而与ARB药物的使用无关。　结论　血液透析患者高钾血症的发生与患者的透析次数、尿量、年龄相关，ARB类药物的使用未增加高钾血症的发生率。
【Abstract】　Objective　 To analyze the risk factors for hyperkalemia and evaluate the security of ARBs application in hemodialysis patients, as angiotensin Ⅱ receptor blockers (ARBs) are commonly used anti-hypertensive drugs in hemodialysis patients, and they may affect the renal excretion of potassium.　Methods　 The clinical data of 95 hemodialysis patients were investigated from January 2010 to July 2010. We compared the incidence of hyperkalemia in ARBs group and non-ARBs group, and also analyzed the correlation between the possible risk factors and hyperkalemia incidence.　Results　 There were 47 patients in the ARBs group and 48 patients in the non-ARBs group. Fifteen patients (31.9%) in the ARBs group and 14 (29.2%) in the non-ARBs group had hyperkalemia, and there was no significant difference in the proportion of patients who had hyperkalemia between the two groups (P gt;0.05). Compared with patients without hyperkalemia, patients with hyperkalemia were younger [(47.69±13.64) vs. (54.50±13.54) years, P lt;0.05], and more often had urine volume less than 400 mL (89.7% vs. 57.6%, P lt;0.05). Logistic regression analysis showed that the incidence of hyperkalemia was related to age, frequency of dialysis, and urine volume, not to ARBs.　Conclusion　 The incidence of hyperkalemia in hemodialysis patients is related to the frequency of dialysis, urine volume and age; ARBs do not increase the incidence of hyperkalemia.

Citation： CHEN Xiaolei,ZHOU Lingyun,FU Ping,TAO Ye,ZHONG Hui. The Correlation between Angiotensin Ⅱ Receptor Blockers and Hyperkalemia in Hemodialysis Patients. West China Medical Journal, 2011, 26(8): 1125-1127. doi: Copy

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1. 　Putcha N, Allon M. Management of hyperkalemia in dialysis patients[J]. Sem in Dial, 2007, 20(5): 431-439.
2. 　Gibbs M, Tayal V. Electrolyte disturbances[M]//Marx J Aeds. Rosen ’s emergency medicine: concepts and clinical practice. 6th Edition. Philadelphia: Mosby, 2006: 1939-1941.
3. 　Evans K, Reddan DN, Szczech LA. Nondialytic management of hyperkalemia and pulm onary edema among end stage renal disease patients: an evaluation of the evidence[J]. Semin Dial, 2004, 17(1): 22-29.
4. 　邹和群. 实用临床肾脏病学[M]. 北京: 中国医药科学技术出版社, 2001: 946-986.
5. 　姚小丹. 血液透析时间延长是否有利?[J]. 肾脏病与透析肾移植杂志, 2000, 9(2): 196-198.
6. 　Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients[J]. Kidney Int, 1990, 38(5): 869-872.
7. 　闫铁昆, 付胜惠, 林珊. 维持性血液透析患者透析前后血钾状态及其影响因素分析[J]. 临床荟萃, 2009, 24(1): 30-32.
8. 　《血管紧张素转换酶抑制剂在肾脏病中正确应用》专家协会组. 血管紧张素转换酶抑制剂在肾脏病中正确应用的专家共识[J]. 中华肾脏病杂志, 2006, 22(1): 57-58.
9. 　Han SW, Won YW, Yi JH, et al. No impact of hyperkalaemia with renin-angiotensin in system blockades in maintenance haemodialysis patients[J]. Nephrol Dial Transplant, 2007, 22(4): 1150-1155.
10. 　Knoll GA, Sahgal A, Nair RC, et al. Renin-angiotensin system blockade and the risk of hyperkalemia in chronic hemodialysis patients[J]. Am J Med, 2002, 112(2): 110-114.
11. 　董洪, 余文慧. 残余肾功能与血液透析患者生活质量的相关性研究[J]. 天津医科大学学报, 2010, 16(3): 488-491.
12. 　谢林伸, 樊均明, 王丰平, 等. CKD患者残存肾功能的意义及保护策略[J]. 中国中西医结合肾病杂志, 2010, 11(2): 167-168.

West China Medical Journal

The Correlation between Angiotensin Ⅱ Receptor Blockers and Hyperkalemia in Hemodialysis Patients

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