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：

血管緊張素受體拮抗劑; 血液透析; 高鉀血癥

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【摘要】　目的　血管緊張素受體拮抗劑（angiotension Ⅱ receptor blockers，ARB）是血液透析患者常用的降壓藥物之一，可對腎臟的排鉀功能產生影響。研究通過對血液透析患者高鉀血癥的發生情況進行調查，了解并分析相關影響因素，探討ARB類藥物在血液透析患者中應用的安全性。　方法　 2010年1月－2010年7月對95例維持性血液透析患者的臨床資料進行調查，比較ARB組和非ARB組高鉀血癥的發生率，并將可能的危險因素和高鉀血癥的發生率進行相關性分析。　結果　納入患者中使用ARB類降壓藥47例，未使用ARB類降壓藥48例。ARB組高鉀血癥15例（31.9%），非ARB組高鉀血癥14例（29.2%），發生率無統計學意義（P gt;0.05）。將高鉀患者和血鉀正常患者做對比，高鉀血癥組年齡較輕[（47.69±13.64）歲，（54.50±13.54）歲；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回歸分析結果顯示，高鉀血癥的發生與年齡、透析次數、尿量相關，而與ARB藥物的使用無關。　結論　血液透析患者高鉀血癥的發生與患者的透析次數、尿量、年齡相關，ARB類藥物的使用未增加高鉀血癥的發生率。
【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. 　鄒和群. 實用臨床腎臟病學[M]. 北京: 中國醫藥科學技術出版社, 2001: 946-986.
5. 　姚小丹. 血液透析時間延長是否有利?[J]. 腎臟病與透析腎移植雜志, 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. 　閆鐵昆, 付勝惠, 林珊. 維持性血液透析患者透析前后血鉀狀態及其影響因素分析[J]. 臨床薈萃, 2009, 24(1): 30-32.
8. 　《血管緊張素轉換酶抑制劑在腎臟病中正確應用》專家協會組. 血管緊張素轉換酶抑制劑在腎臟病中正確應用的專家共識[J]. 中華腎臟病雜志, 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. 殘余腎功能與血液透析患者生活質量的相關性研究[J]. 天津醫科大學學報, 2010, 16(3): 488-491.
12. 　謝林伸, 樊均明, 王豐平, 等. CKD患者殘存腎功能的意義及保護策略[J]. 中國中西醫結合腎病雜志, 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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