【摘要】目的高钾血症是终末期肾病患者的常见合并症之一, 严重高钾血症可引起致死性心律失常而危及生命。本研究旨在探究中国透析预后与实践模式研究(Dialysis Outcomes and Practice Patterns Study，DOPPS)中血液透析(hemodialysis，HD)患者合并高钾血症的情况，并探究血液透析患者合并高钾血症的独立相关因素。方法DOPPS 是1 项国际性的前瞻性观察研究，中国参加了DOPPS5
(2012～2015)，并完成了队列的随访。中国DOPPS5 中纳入了1427 名患者。以这些患者为研究对象，收集实验检查中透析前血钾的值，分为正常血钾组(血钾＜5.5mmol/L)和高钾血症组(血钾≥5.5mmol/L)。根据严重程度进一步将高钾血症分为轻度(5.5～5.9 mmol/L)、中度(6.0～6.4mmol/L)或重度(≥6.5 mmol/L)。比较2 组间的一般资料、实验室检查及透析处方间的差异，并用多因素Logistic 回归分析探究高钾血症的独立相关因素。结果本研究共纳入了1339 名HD 患者，平均年龄为(59.4±14.9)岁，中位透析龄为2.6(0.9,5.3)年，男性占54.4%。合并高钾血症的患者为345 人(25.8%)，其中轻度高钾血症占13.3%，中度高钾血症占7.6%，重度高钾血症占4.9%。3 个城市中，北京的HD 患者合并高钾血症的比例最高(31.8% )，其次是广州(26.0% )，上海的患者中合并高钾血症的比例最低(19.3% ) (χ2=18.580，P＜0.001)。血钾正常和高钾血症的2 组患者在年龄(t=2.610,P=0.009)、性别比例(χ2= 4.059, P=0.007)、BMI (t=-2.680,P=0.008)、透析充分性(t=4.280,P＜0.001)、透析频次(χ2=21.548,P＜0.001)、血白蛋白(t=6.071, P＜0.001)、血磷(t=7.083, P＜0.001)等方面均有显著差异。多因素Logistic 回归分析示，较高的BMI(OR:1.040,95% CI:1.004～1.077，P=0.027)、女性(OR：1.201,95% CI：1.023～2.547，P=0.026)、透析液钾浓度≥2.5mEq/L(相比于＜2.5mEq/L)(OR：1.194,95% CI：1.028～1.386，P=0.020)、透析充分性不达标(stdKt/V＜2)(OR：1.336,95% CI：1.170～1.527，P＜0.001)、透析频次低于每周3 次(OR：1.332, 95% CI：1.150～1.544，P＜0.001)、血白蛋白水平高(OR：1.815,95% CI：1.294～2.547，P＜0.001)、血磷水平高(OR：1.231,95% CI：1.153～1.316，P＜0.001)是与HD 患者合并高钾血症的独立相关因素。结论在中国DOPPS5 研究中，25.8%的HD 患者合并高钾血症。纳入的3 个城市中，北京患者中合并高钾血症的比例最高，其次是广州，上海最低。较高的BMI、女性、透析液钾浓度≥2.5mEq/L(相比于＜2.5mEq/L)、透析充分性不达标(stdKt/V＜2)、透析频次低于每周3 次、血白蛋白水平高、血磷水平高是HD 患者合并高钾血症的独立相关因素。
Abstract
【Abstract】Objective Hyperkalemia is a common complication in patients with end stage renal disease due to impaired renal potassium excretion. Higher pre-dialysis serum potassium may cause heart rhythm disturbances and even fatal cardiac arrest. This study assessed the prevalence of hyperkalemia in hemodialysis (HD) patients based on the China Dialysis Outcomes and Practice Patterns Study (DOPPS), and explored the independent risk factors of hyperkalemia in HD patients. Methods DOPPS is an international prospective and observational study. China participates in the DOPPS5 (2012～2015) and has completed the follow-up study of the cohort. A total of 1,427 HD patients included in the China DOPPS5. We recruited their pre-dialysis serum potassium and clinical data, and divided them into normal potassium group and hyperkalemia group (serum potassium ≥5.5mmol/L). Their demographic information, laboratory data and dialysis prescriptions were compared between the two groups. The independent risk factors for hyperkalemia were explored using multivariate logistic regression analysis. Results A total of 1,339 HD patients were enrolled in this study, with an average age of 59.4±14.9 years, 54.4% males, and an average dialysis vintage of 2.6 (0.9, 5.3) years. Hyperkalemia was detected in 345 patients (25.8%), of which 13.3% were mild hyperkalemia, 7.6% were moderate hyperkalemia, and 4.9% were severe hyperkalemia. Among the three cities involved in this study, the HD patients in Beijing had the highest rate of hyperkalemia (31.8%), followed by Guangzhou (26.0%) and Shanghai (19.3%) (χ2=18.580, P＜0.001). There were significant differences in age (t=2.610, P=0.009), gender (χ2=4.059, P=0.007), BMI (t=-2.680, P=0.008), dialysis adequacy (t=4.280, P＜0.001), dialysis frequency (χ2=21.548, P＜0.001), serum albumin (t=6.071, P＜0.001), and serum phosphorus (t=7.083, P＜0.001) between normal potassium group and hyperkalemia group. Multivariate logistic regression showed that higher
BMI (OR: 1.040, 95% CI: 1.004～1.077, P=0.027), female gender (OR:1.201, 95% CI: 1.023～2.547, P=0.026), potassium concentration in dialysate≥2.5mEq/L (compared to <2.5mEq/L) (OR: 1.194, 95% CI:1.028～1.386, P=0.020), lower dialysis adequacy (stdKt/V<2) (OR: 1.336, 95% CI: 1.170～1.527, P＜0.001), dialysis frequency＜3 times per week (OR: 1.332, 95% CI: 1.150～1.544, P＜0.001), higher serum albumin (OR: 1.815, 95% CI: 1.294～2.547, P＜0.001) and higher serum phosphorus (OR: 1.231, 95% CI: 1.153～1.316, P＜0.001) were the independent risk factors for hyperkalemia in HD patients (P＜0.05). Conclusion
The China DOPPS5 of hyperkalemia in HD patients found that hyperkalemia was detected in 25.8% HD patients. Among the three cities involved in this study, the HD patients in Beijing had the highest rate of hyperkalemia (31.8%), followed by Guangzhou (26.0%) and Shanghai (19.3%). Higher BMI, female gender, dialysate potassium concentration≥2.5mEq/L, stdKt/V＜2, dialysis frequency＜3 times per week, higher serum albumin and phosphorus levels were the independent risk factors for hyperkalemia in HD patients.
关键词
血液透析 /
高钾血症 /
DOPPS 研究
Key words
Hemodialysis /
Hyperkalemia /
DOPPS
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基金
国家自然科学基金：肝素类物质对导致骨质疏松的机制研究(81870524)
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