终末期肾病患者初次腹膜透析低钾发生率及危险因素分析
|
摘要
目的探讨初次行持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)的终末期肾病(end-stage renal disease,ESRD)患者低钾的发生率及影响因素。方法收集2011年1月～2016年10月在四川大学华西医院肾脏内科初次行腹膜透析(peritoneal dialysis, PD)置管的350例CAPD患者的临床数据。根据术后初次血钾水平分为低钾组(<3.5mmol/L)和非低钾组(≥3.5mmol/L)。结果低钾组65例(18.57%),与非低钾组相比,血清白蛋白(Z=-3.695,P<0.001)、尿量(Z=-3.413,P=0.001)水平较低,而年龄(χ~2=7.627,P=0.006)、白细胞介素-6(Z=-2.832,P=0.005)、Kt/V(Z=-2.543,P=0.011)、4h透析液与血肌酐比值(D/P Cr(4h))(Z=-2.686,P=0.007)偏高。2组间性别(χ~2=0.357,P=0.550)、血红蛋白(Z=-0.031,P=0.975)、超滤量(Z=-1.105,P=0.269)、透析龄(Z=-0.041,P=0.967)差异均无统计学意义。相关分析显示:血钾水平与血清白蛋白(r=0.185,P<0.001)、尿量(r=0.136,P=0.011)呈正相关,与年龄(r=-0.142,P=0.008)、D/P Cr(4h)(r=-0.185,P=0.001)、透析Kt/V(r=-0.188,P<0.001)呈负相关。逐步多元线性回归分析显示:年龄(β=-0.006,P=0.011)、血清白蛋白(β=0.017,P=0.013)、每周总Kt/V(β=-0.181,P=0.005)、二氧化碳结合力(β=-0.061,P<0.001)、尿量(β=0,P=0.016)是低血钾的危险因素。结论初次腹膜透析的ESRD患者低钾发生率较高;应关注初次腹膜透析患者的血钾情况,尤其是老年及营养不良者。
Objectives T o evaluate the incidence of hypokalemia and the factors associated with hypokalemia among patients with primary continuous ambulatory peritoneal dialysis(CAPD).Methods Clinical data of the 350 eligible CAPD patients undergoing peritoneal catheter placement in West China Hospital of Sichuan university from January 2011 to November 2016 were collected.The patients were divided into hypokalemia group(<3.5 mmol/L) and non-hypokalemia group(≥3.5 mmol/L) based on the first serum potassium level.Results Hypokalemia group included 65 cases(18.57%).Serum albumin(Z=-3.695,P<0.001),urine volume(Z=-3.413,P=0.001) were lower in hypokalemia group than in non-hypokalemia group.In contrast,age(χ~2=7.627,P=0.006),serum IL-6(Z=-2.832,P=0.005),dialysate Kt/V(Z=-2.543,P=0.011),4-hour dialysate to plasma creatinine ratio(Z=-2.686,P=0.007) were higher in hypokalemia group than in non-hypokalemia group.There were no significant differences in gender(χ~2=0.357,P=0.550),hemoglobin(Z=-0.031,P=0.975),ultrafiltration capacity(Z=-1.105,P=0.269) and duration of CAPD(Z=-0.041,P=0.967) between the two groups.Pearson correlation analysis showed that serum potassium level correlated positively with serum albumin(r=0.185,P<0.001),urine volume(r=0.036,P=0.011);and negatively with age(r=-0.142,P=0.008),D/P Cr(4 h)(r=-0.185,P=0.001) and dialysate Kt/V(r=-0.188,P<0.001).Multivariate stepwise linear regression analysis revealed that age(β =-0.006,P=0.011),serum albumin(β =0.017,P=0.013),total Kt/V(β =-0.181,P=0.005),CO2 CP(β=-0.061,P<0.001) and urine volume(β=0,P=0.016) were the risk factors for hypokalemia.Conclusion A higher incidence of hypokalemia is observed in primary CAPD patients.We should pay attention to serum potassium in PD patients,especially in senile and poor nutrition patients.
Objectives T o evaluate the incidence of hypokalemia and the factors associated with hypokalemia among patients with primary continuous ambulatory peritoneal dialysis(CAPD).Methods Clinical data of the 350 eligible CAPD patients undergoing peritoneal catheter placement in West China Hospital of Sichuan university from January 2011 to November 2016 were collected.The patients were divided into hypokalemia group(<3.5 mmol/L) and non-hypokalemia group(≥3.5 mmol/L) based on the first serum potassium level.Results Hypokalemia group included 65 cases(18.57%).Serum albumin(Z=-3.695,P<0.001),urine volume(Z=-3.413,P=0.001) were lower in hypokalemia group than in non-hypokalemia group.In contrast,age(χ~2=7.627,P=0.006),serum IL-6(Z=-2.832,P=0.005),dialysate Kt/V(Z=-2.543,P=0.011),4-hour dialysate to plasma creatinine ratio(Z=-2.686,P=0.007) were higher in hypokalemia group than in non-hypokalemia group.There were no significant differences in gender(χ~2=0.357,P=0.550),hemoglobin(Z=-0.031,P=0.975),ultrafiltration capacity(Z=-1.105,P=0.269) and duration of CAPD(Z=-0.041,P=0.967) between the two groups.Pearson correlation analysis showed that serum potassium level correlated positively with serum albumin(r=0.185,P<0.001),urine volume(r=0.036,P=0.011);and negatively with age(r=-0.142,P=0.008),D/P Cr(4 h)(r=-0.185,P=0.001) and dialysate Kt/V(r=-0.188,P<0.001).Multivariate stepwise linear regression analysis revealed that age(β =-0.006,P=0.011),serum albumin(β =0.017,P=0.013),total Kt/V(β =-0.181,P=0.005),CO2 CP(β=-0.061,P<0.001) and urine volume(β=0,P=0.016) were the risk factors for hypokalemia.Conclusion A higher incidence of hypokalemia is observed in primary CAPD patients.We should pay attention to serum potassium in PD patients,especially in senile and poor nutrition patients.
引文
[1]Khan AN,Bernardini J,Johnston JR,et al.Hypokalemia in peritoneal dialysis patients[J].Perit Dial Int,1996,16(6):652.
[2]Zanger R.Hyponatremia and hypokalemia in patients on peritoneal dialysis[J].Semin Dial,2010,23:575-580.
[3]Spital A,Sterns RH.Potassium supplementation via the dialysate in continuous ambulatory peritoneal dialysis[J].Am J Kidney Dis,1985,6(3):173-176.
[4]Tziviskou E,Musso C,Bellizzi V,et al.Prevalence and pathogenesis of hypokalemia in patients on chronic peritoneal dialysis:One center’s experience and review of the literature[J].Int Urol Nephrol,2003,35:429-434.
[5]Torlen K,Kalantar-Zadeh K,Molnar MZ,et al.Serum potassium and cause specific mortality in a large peritoneal dialysis cohort[J].Clin J Am Soc Nephrol,2012,7(8):1272-1284.
[6]Szeto CC,Chow KM,Kwan BC,et al.Hypokalemia in Chinese peritoneal dialysis patients:prevalence and prognostic implication[J].Am J Kidney Dis,2005,46(1):128-135.
[7]Hoppe LK,Muhlack DC,Koenig W,et al.Association of Abnormal Serum Potassium Levels with Arrhythmias and Cardiovascular Mortality:a Systematic Review and MetaAnalysis of Observational Studies[J].Cardiovasc Drugs Ther,2018,32(2):197-212.
[8]韩庆烽.腹膜透析患者心脑血管疾病的危险因素.[J].中国血液净化,2018,17(8):505-507.
[9]Ribeiro SC,Figueiredo AE,Barretti P,et al.Low Serum Potassium Levels Increase the Infectious-Caused Mortality in Peritoneal Dialysis Patients:A PropensityMatched Score Study[J].PLoS One,2015,10(6):e0127453.
[10]杨荟,曾玉纯,汤颖,等.腹膜透析患者低钾血症的危险因素分析[J].岭南急诊医学,2017,22(5):462-464.
[11]Xu Q,Xu F,Fan L,et al.Serum potassium levels and its variability in incident peritoneal dialysis patients:associations with mortality[J].PLoS One,2014,9(1):e86750.
[12]刘远浩.腹膜透析患者低钾血症影响因素分析[J].内科,2015,10(5):613-615.
[13]Vavruk AM,Martins C,Nascimento MM,et al.Association between hypokalemia,malnutrition and mortality in peritoneal dialysis patients][J].J Bras Nefrol,2012,34(4):349-354.
[14]Yang X,Tong Y,Yan H,et al.High Intraperitoneal Interleukin-6 Levels Predict Peritonitis in Peritoneal Dialysis Patients:A Prospective Cohort Study[J].Am JNephrol,2018,47(5):317-324.
[15]Yang X,Zhang H,Hang Y,et al.Intraperitoneal interleukin-6 levels predict peritoneal solute transport rate:a prospective cohort study[J].Am J Nephrol,2014,39(6):459-465.
[16]Carrero JJ,Stenvinkel P,Cuppari L,et al.Etiology of the protein-energy wasting syndrome in chronic kidney disease:a consensus statement from the International Society of Renal Nutrition and Metabolism(ISRNM)[J].J Ren Nutr,2013,23:77-90.
[17]Zhang W,He J,Zhang F,et al.Prognostic role of C-reactive protein and interleukin-6 in dialysis patients:a systematic review and meta-analysis[J].J Nephrol,2013,26(2):243-253.··
[2]Zanger R.Hyponatremia and hypokalemia in patients on peritoneal dialysis[J].Semin Dial,2010,23:575-580.
[3]Spital A,Sterns RH.Potassium supplementation via the dialysate in continuous ambulatory peritoneal dialysis[J].Am J Kidney Dis,1985,6(3):173-176.
[4]Tziviskou E,Musso C,Bellizzi V,et al.Prevalence and pathogenesis of hypokalemia in patients on chronic peritoneal dialysis:One center’s experience and review of the literature[J].Int Urol Nephrol,2003,35:429-434.
[5]Torlen K,Kalantar-Zadeh K,Molnar MZ,et al.Serum potassium and cause specific mortality in a large peritoneal dialysis cohort[J].Clin J Am Soc Nephrol,2012,7(8):1272-1284.
[6]Szeto CC,Chow KM,Kwan BC,et al.Hypokalemia in Chinese peritoneal dialysis patients:prevalence and prognostic implication[J].Am J Kidney Dis,2005,46(1):128-135.
[7]Hoppe LK,Muhlack DC,Koenig W,et al.Association of Abnormal Serum Potassium Levels with Arrhythmias and Cardiovascular Mortality:a Systematic Review and MetaAnalysis of Observational Studies[J].Cardiovasc Drugs Ther,2018,32(2):197-212.
[8]韩庆烽.腹膜透析患者心脑血管疾病的危险因素.[J].中国血液净化,2018,17(8):505-507.
[9]Ribeiro SC,Figueiredo AE,Barretti P,et al.Low Serum Potassium Levels Increase the Infectious-Caused Mortality in Peritoneal Dialysis Patients:A PropensityMatched Score Study[J].PLoS One,2015,10(6):e0127453.
[10]杨荟,曾玉纯,汤颖,等.腹膜透析患者低钾血症的危险因素分析[J].岭南急诊医学,2017,22(5):462-464.
[11]Xu Q,Xu F,Fan L,et al.Serum potassium levels and its variability in incident peritoneal dialysis patients:associations with mortality[J].PLoS One,2014,9(1):e86750.
[12]刘远浩.腹膜透析患者低钾血症影响因素分析[J].内科,2015,10(5):613-615.
[13]Vavruk AM,Martins C,Nascimento MM,et al.Association between hypokalemia,malnutrition and mortality in peritoneal dialysis patients][J].J Bras Nefrol,2012,34(4):349-354.
[14]Yang X,Tong Y,Yan H,et al.High Intraperitoneal Interleukin-6 Levels Predict Peritonitis in Peritoneal Dialysis Patients:A Prospective Cohort Study[J].Am JNephrol,2018,47(5):317-324.
[15]Yang X,Zhang H,Hang Y,et al.Intraperitoneal interleukin-6 levels predict peritoneal solute transport rate:a prospective cohort study[J].Am J Nephrol,2014,39(6):459-465.
[16]Carrero JJ,Stenvinkel P,Cuppari L,et al.Etiology of the protein-energy wasting syndrome in chronic kidney disease:a consensus statement from the International Society of Renal Nutrition and Metabolism(ISRNM)[J].J Ren Nutr,2013,23:77-90.
[17]Zhang W,He J,Zhang F,et al.Prognostic role of C-reactive protein and interleukin-6 in dialysis patients:a systematic review and meta-analysis[J].J Nephrol,2013,26(2):243-253.··