中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (07): 525-529.doi: 10.3969/j.issn.1671-4091.2022.07.014

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肾素-血管紧张素-醛固酮抑制剂与维持性血液透析患者高钾血症 

何诗婷   谢伟基   张益民   

  1. 515041 汕头，1汕头大学医学院第二附属医院肾内科
    510655 广州，    2中山大学附属第六医院肾内科

  • 收稿日期:2022-01-04 修回日期:2022-04-15 出版日期:2022-07-12 发布日期:2022-07-12
  • 通讯作者: 张益民 E-mail:zhangyim@mail.sysu.edu.cn

Renin-angiotensin-aldosterone inhibitor and hyperkalemia in patients with maintenance hemodialysis

  1. Department of Nephrology, The Second Affiliated Hospital of  Shantou University Medical College, Guangdong 515041, China; 2Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong 510655, China
  • Received:2022-01-04 Revised:2022-04-15 Online:2022-07-12 Published:2022-07-12

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摘要： 肾素-血管紧张素-醛固酮抑制剂(renin-angiotensin-aldosterone Inhibitor,RASi)在降低血压和维护心肾功能中发挥着重要的作用，但RASi会阻止醛固酮分泌并引起高钾血症(hyperkalemia)。鉴于RASi可能导致肾小球滤过率已经下降的慢性肾脏病(chronic kidney disease,CKD)患者血肌酐升高及高钾血症，此类药物在非透析CKD 4～5期患者中存在顾虑。而对于维持性血液透析(maintenance hemodialysis,MHD)人群，由于存在较多影响MHD患者血钾的因素(如饮食、清除率、药物等)且诸多因素间可能存在交互作用，RASi的安全性的问题尚有争议。

关键词: 血液透析, 高钾血症, 肾素-血管紧张素-醛固酮抑制剂

Abstract: Renin-angiotensin-aldosterone inhibitor (RASi) plays an important role in lowering blood pressure and maintaining cardiac and renal function, but it also blocks the secretion of aldosterone and causes hyperkalemia. Given that RASi may lead to elevated serum creatinine and hyperkalemia in patients with chronic kidney disease (CKD) whose glomerular filtration rate has decreased, there are concerns about the use of such drugs in patients with nondialysis stage CKD 4-5. For people on maintenance hemodialysis (MHD), the safety of RASi is controversial due to the presence of factors (such as diet, clearance, medication, etc.) that affect the blood potassium of patients with MHD and the possible interaction between many factors.

Key words: Hemodialysis, Hyperkalemia, Renin-angiotensin-aldosterone inhibitor

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