维持性血液透析患者血液透析前后的血钾波动

doi:10.3969/j.issn.1004-583X.2024.09.005

摘要/Abstract

摘要：

目的观察维持性血液透析 (maintenance hemodialysis,MHD)患者血液透析(透析)前后的血钾波动。方法纳入2021年2月至2023年2月就诊于遵义市中医院肾病风湿科的MHD患者42例,采用中位数分组法分为Δ血钾(透析前后血钾差值)≥1.44 mmol/L组(n=21)和Δ血钾<1.44 mmol/L 组(n=21),比较两组临床资料的差异。结果两组年龄、性别、URR、sp Kt/V、HD模式差异均无统计学意义(P>0.05);与Δ血钾<1.44 mmol/L组比较,Δ血钾≥1.44 mmol/L组基础病为非糖尿病肾病占比较大(P=0.019)、透析前血钾水平更高(P<0.001)。偏相关分析显示, 在校正年龄后,Δ血钾仍与透析前后血钾呈正相关,且Δ血钾与透析前血钾的正相关性更为显著(p<0.05)。结论基础病为非糖尿病肾病和透析前血钾高水平与MHD患者透析前后血钾波动较大相关,临床应引起重视。

关键词: 维持性血液透析, 血钾波动, 影响因素

Abstract:

Objective To observe the fluctuations of serum potassium in maintenance hemodialysis (MHD) patients before and after hemodialysis.Methods A total of 42 MHD patients admitted in the Nephrology and Rheumatology Department of Zunyi Hospital of Traditional Chinese Medicine from February 2021 to February 2023 were selected. According to the median grouping method, patients were divided into Δserum potassium (difference of serum potassium before and after dialysis) ≥1.44 mmol/L group (n=21) and Δserum potassium <1.44 mmol/L group (n=21). Clinical data between the two groups were compared. Results There were no significant differences in the age, gender, urea reduction ratio (URR), single-pool urea Kt/V (sp Kt/V) and hemodialysis (HD) mode between the two groups (P>0.05). Compared with the Δserum potassium <1.44 mmol/L group, the proportion of non-diabetic nephropathy (P =0.019) and serum potassium before dialysis were significantly higher in the Δserum potassium ≥1.44 mmol/L group (P <0.001). Partial correlation analysis showed that after adjusting for age, Δserum potassium was positively correlated with serum potassium before and after dialysis, and the positive correlation between Δserum potassium and serum potassium before dialysis was more significant (P <0.05).Conclusion Non-diabetic nephropathy as the comorbidity and the high-level serum potassium before MHD is related to the large fluctuation of serum potassium before and after MHD, which should be paid attention to in clinical practice.

Key words: maintenance hemodialysis, blood potassium fluctuations, influencing factor

中图分类号:

R459.5

杨海燕, 陈玲, 代博, 刘霞, 孙尚萍. 维持性血液透析患者血液透析前后的血钾波动[J]. 临床荟萃, 2024, 39(9): 798-802.

Yang Haiyan, Chen Ling, Dai Bo, Liu Xia, Sun Shangping. Blood potassium fluctuations before and after dialysis in maintenance hemodialysis patients[J]. Clinical Focus, 2024, 39(9): 798-802.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.09.005

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I9/798

图/表 3

表1 两组一般资料比较

Tab.1 Basic characteristics between the two groups

组别	例数	年龄 (岁)	基础病[例(%)]		性别[例(%)]		HD模式[例(%)]
组别	例数	年龄 (岁)	非糖尿病肾病	糖尿病肾病	男性	女性	HD	HDF	HD+HP
Δ血钾≥1.44 mmol/L组	21	56.19±12.75	18(85.7)	3(14.3)	9(42.8)	12(57.2)	11(52.4)	4(19.0)	6(28.6)
Δ血钾<1.44 mmol/L组	21	62.95±13.68	11(52.4)	10(47.6)	9(42.8)	12(57.2)	15(71.4)	4(19.0)	2(9.6)
统计值		$t$ =1.657	χ²=5.459		χ²=0.857		χ²=2.711
P值		0.105	0.019		0.355		0.258

表1 两组一般资料比较

Tab.1 Basic characteristics between the two groups

组别	例数	年龄 (岁)	基础病[例(%)]		性别[例(%)]		HD模式[例(%)]
组别	例数	年龄 (岁)	非糖尿病肾病	糖尿病肾病	男性	女性	HD	HDF	HD+HP
Δ血钾≥1.44 mmol/L组	21	56.19±12.75	18(85.7)	3(14.3)	9(42.8)	12(57.2)	11(52.4)	4(19.0)	6(28.6)
Δ血钾<1.44 mmol/L组	21	62.95±13.68	11(52.4)	10(47.6)	9(42.8)	12(57.2)	15(71.4)	4(19.0)	2(9.6)
统计值		$t$ =1.657	χ²=5.459		χ²=0.857		χ²=2.711
P值		0.105	0.019		0.355		0.258

表2 两组实验室资料比较

Tab.2 Laboratory data between the two groups

组别	例数	HD前血钾 (mmol/L)	HD后血钾 (mmol/L)	Δ血钾	URR (%)	sp Kt/V
Δ血钾≥1.44 mmol/L组	21	5.40±0.64	3.25±0.26	2.15±0.51	71.39(69.69, 78.58)	1.49(1.40, 1.84)
Δ血钾<1.44 mmol/L组	21	4.02±0.36	2.93±0.29	1.09±0.21	71.14(69.28, 73.31)	1.44(1.37, 1.52)
统计值		$t$ =-8.619	$t$ =-3.839	$t$ =-8.715	$Z$ =0.616	$Z$ =1.158
P值		<0.001	<0.001	<0.001	0.538	0.247

表2 两组实验室资料比较

Tab.2 Laboratory data between the two groups

组别	例数	HD前血钾 (mmol/L)	HD后血钾 (mmol/L)	Δ血钾	URR (%)	sp Kt/V
Δ血钾≥1.44 mmol/L组	21	5.40±0.64	3.25±0.26	2.15±0.51	71.39(69.69, 78.58)	1.49(1.40, 1.84)
Δ血钾<1.44 mmol/L组	21	4.02±0.36	2.93±0.29	1.09±0.21	71.14(69.28, 73.31)	1.44(1.37, 1.52)
统计值		$t$ =-8.619	$t$ =-3.839	$t$ =-8.715	$Z$ =0.616	$Z$ =1.158
P值		<0.001	<0.001	<0.001	0.538	0.247

表3 Δ血钾与HD相关指标的偏相关分析

Tab.3 Partial correlation analysis of Δ serum potassium and HD related indicators

指标	未校正		校正后
指标	$r$ 值	P值	$r'$ 值	P值
HD前血钾	0.950	<0.001	0.949	<0.001
sp Kt/V	0.306	0.049	0.270	0.088
URR	0.174	0.270	0.165	0.303
HD后血钾	0.515	<0.001	0.445	0.004
年龄	-0.299	0.054	-	-

表3 Δ血钾与HD相关指标的偏相关分析

Tab.3 Partial correlation analysis of Δ serum potassium and HD related indicators

指标	未校正		校正后
指标	$r$ 值	P值	$r'$ 值	P值
HD前血钾	0.950	<0.001	0.949	<0.001
sp Kt/V	0.306	0.049	0.270	0.088
URR	0.174	0.270	0.165	0.303
HD后血钾	0.515	<0.001	0.445	0.004
年龄	-0.299	0.054	-	-

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