留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

心脏移植术后高钾血症的危险因素及预测分析

陈斯瑶, 吴敏, 黄劲松, 等. 心脏移植术后高钾血症的危险因素及预测分析[J]. 器官移植, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
引用本文: 陈斯瑶, 吴敏, 黄劲松, 等. 心脏移植术后高钾血症的危险因素及预测分析[J]. 器官移植, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
Chen Siyao, Wu Min, Huang Jinsong, et al. Risk factors and predictive analysis of hyperkalemia after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014
Citation: Chen Siyao, Wu Min, Huang Jinsong, et al. Risk factors and predictive analysis of hyperkalemia after heart transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 106-112. doi: 10.3969/j.issn.1674-7445.2023.01.014

心脏移植术后高钾血症的危险因素及预测分析

doi: 10.3969/j.issn.1674-7445.2023.01.014
基金项目: 

国家自然科学基金青年基金 82000081

广州市基础研究计划基础与应用基础研究项目 202201011721

详细信息
    作者简介:
    通讯作者:

    吴怡锦,博士,副主任医师,研究方向为心脏移植,Email:wuyijin@gdph.org.cn

  • 中图分类号: R617, R541

Risk factors and predictive analysis of hyperkalemia after heart transplantation

More Information
  • 摘要:   目的  分析心脏移植受者术后发生高钾血症的预后、危险因素及其预测指标。  方法  回顾性分析158例受者的临床资料,根据受者术后随访1年内的血钾水平分为正常血钾组(83例)、高钾血症组(43例)及重度高钾血症组(32例)。总结心脏移植术后高钾血症的发生情况及预后,分析心脏移植术后高钾血症的危险因素及预测指标。  结果  心脏移植术后1年高钾血症发生率为47.5%(75/158),重度高钾血症发生率20.3%(32/158)。重度高钾血症组的病死率为16%(5/32),高于正常血钾组的8%(7/83)和高钾血症组的7%(3/43)。术前半年血清肌酐(Scr)平均值、术前末次总胆红素、术后血液透析时间、术后1 d Scr及术后1 d脑钠肽前体是心脏移植术后发生高钾血症的独立危险因素(均为P < 0.05)。术前半年Scr平均值、术后血液透析时间和术后1 d Scr、术后7 d Scr可预测术后重度高钾血症。  结论  心脏移植术后重度高钾血症的结局欠佳,心脏移植术后发生高钾血症的独立危险因素包括术前半年Scr平均值、术前末次总胆红素、术后血液透析时间、术后1 d Scr及术后1 d脑钠肽前体,围手术期Scr及术后血液透析时间可预测心脏移植术后1年内重度高钾血症。

     

  • 图  1  心脏移植围手术期临床指标预测术后重度高钾血症的ROC曲线

    Figure  1.  ROC curves of perioperative clinical indicators for predicting severe hyperkalemia after heart transplantation

    表  1  心脏移植术后发生高钾血症危险因素的单因素分析

    Table  1.   Univariate analysis of risk factors for hyperkalemia after heart transplantation

    变量 分组 统计值 P
    正常血钾组(n=83) 高钾血症组(n=43) 重度高钾血症组(n=32)
    术前资料
      高血压[n(%)] 9(11) 6(14) 10(31)a, b 7.376 0.025
      糖尿病[n(%)] 13(16) 8(19) 9(28) 2.338 0.311
      慢性肾病[n(%)] 1(1) 2(5) 5(16)a, b 10.012 0.007
      术前半年Scr平均值(x±s,μmol/L) 89±23 100±20 131±48a, b 23.462 < 0.001
      术前末次Scr(x±s,μmol/L) 87±23 97±23 134±52a, b 26.156 < 0.001
      术前末次血钾(x±s,mmol/L) 4.0±0.4 4.2±0.5a 4.1±0.5 3.644 0.028
      术前末次总胆红素[M(P25, P75),μmol/L] 20(14, 28) 26(17, 39) a 23(15, 35) 6.292 0.038
      术前末次尿pH值(x±s) 5.8±0.7 5.8±0.6 5.8±0.6 0.139 0.870
      使用呼吸机[n(%)] 7(8) 4(9) 2(6) 0.236 0.889
      机械辅助循环[n(%)] 5(6) 2(5) 4(13) 5.110 0.276
    术中资料
      体外循环时间[M(P25, P75),min] 249(215, 287) 230(205, 267) 229(204, 270) 3.843 0.146
      阻断时间[M(P25, P75),min] 126(113, 140) 124(107, 139) 116(103, 142) 3.319 0.190
      冷缺血时间[M(P25, P75),min] 207(186, 240) 210(189, 233) 187(159, 231) 4.523 0.104
      出血量[M(P25, P75),mL] 300(300, 500) 400(300, 500) 300(225, 400) 2.152 0.341
      输冷沉淀量[M(P25, P75),U] 0(0, 0) 0(0, 10.0) 0(0, 9.9) 3.468 0.177
      术中尿量[M(P25, P75),mL] 500(300, 1 000) 600(350, 1 100) 500(350, 850) 0.941 0.625
    术后资料
      机械辅助循环[n(%)] 11.608 0.021
        无 65(78) 31(72) 15(47)a, b
        1种 13(16) 9(21) 11(34)
        2种 5(6) 3(7) 6(19)
      血液透析[n(%)] 22(27) 18(42) 28(88)a, b 35.082 < 0.001
      血液透析时间[M(P25, P75),h] 0(0, 0) 2.3(0, 11.0) 28.5 (3.3, 49.8)a, b 45.684 < 0.001
      术后当日血钾(x±s,mmol/L) 3.9±0.5 3.8±0.5 4.0±0.5 2.216 0.112
      术后1 d尿酸(x±s,μmol/L) 519±147 563±172 556±217 1.126 0.327
      术后1 d Scr[M(P25, P75),μmol/L] 135(103, 158) 163(123, 196) a 209(180, 270) b 34.517 < 0.001
      术后7 d Scr[M(P25, P75),μmol/L] 101(77, 156) 148(108, 229) 252(157, 410)a, b 35.160 < 0.001
      术后1 d脑钠肽前体[M(P25, P75),pg/mL] 2 406(982, 4 185) 3 321(1 031, 8 763) 4 734(1 774, 11 180)a 8.788 0.012
    注:与正常血钾组比较,aP < 0.05/3; 与高钾血症组比较,bP < 0.05/3。
    下载: 导出CSV

    表  2  心脏移植术后发生高钾血症危险因素的多因素分析

    Table  2.   Multivariate analysis of risk factors for hyperkalemia after heart transplantation

    变量 回归系数 标准误 Wald χ2 OR①值 95% CI P
    术前半年Scr平均值 0.032 0.006 31.091 1.033 1.021 ~ 1.045 < 0.001
    术前末次总胆红素 0.022 0.009 5.489 1.022 1.004 ~ 1.041 0.019
    术后血液透析时间 0.032 0.010 9.736 1.033 1.012 ~ 1.054 0.002
    术后1 d Scr 0.012 0.004 9.872 1.012 1.005 ~ 1.020 0.002
    术后7 d Scr 0.003 0.002 3.126 1.003 1.000 ~ 1.006 0.077
    术后1 d脑钠肽前体 0.000 10 0.000 03 7.695 1.000 10 1.000 02 ~ 1.000 12 0.006
    注:①OR为比值比。
    CI为可信区间。
    下载: 导出CSV
  • [1] SINGH J, KICHLOO A, VIPPARLA N, et al. Hyperkalemia: major but still understudied complication among heart transplant recipients[J]. World J Transplant, 2021, 11(6): 203-211. DOI: 10.5500/wjt.v11.i6.203.
    [2] URIEL M, HOLZHAUSER L, NGUYEN A, et al. Incidence and clinical significance of hyperkalemia following heart transplantation[J]. Transplant Proc, 2021, 53(2): 673-680. DOI: 10.1016/j.transproceed.2020.11.002.
    [3] PALMER BF, CARRERO JJ, CLEGG DJ, et al. Clinical management of hyperkalemia[J]. Mayo Clin Proc, 2021, 96(3): 744-762. DOI: 10.1016/j.mayocp.2020.06.014.
    [4] ZHAO R, HAO X, WANG F, et al. The characteristic and dynamic electrocardiogram changes on hyperkalemia in a hemodialysis patient with heart failure: a case report[J]. J Geriatr Cardiol, 2022, 19(2): 163-166. DOI: 10.11909/j.issn.1671-5411.2022.02.010.
    [5] WAGENER G, BEZINOVER D, WANG C, et al. Fluid management during kidney transplantation: a consensus statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists[J]. Transplantation, 2021, 105(8): 1677-1684. DOI: 10.1097/TP.0000000000003581.
    [6] LONG B, WARIX JR, KOYFMAN A. Controversies in management of hyperkalemia[J]. J Emerg Med, 2018, 55(2): 192-205. DOI: 10.1016/j.jemermed.2018.04.004.
    [7] SARNOWSKI A, GAMA RM, DAWSON A, et al. Hyperkalemia in chronic kidney disease: links, risks and management[J]. Int J Nephrol Renovasc Dis, 2022, 15: 215-228. DOI: 10.2147/IJNRD.S326464.
    [8] GUPTA AA, SELF M, MUELLER M, et al. Dispelling myths and misconceptions about the treatment of acute hyperkalemia[J]. Am J Emerg Med, 2022, 52: 85-91. DOI: 10.1016/j.ajem.2021.11.030.
    [9] WETMORE JB, YAN H, PENG Y, et al. Development and outcomes of hyperkalemia in hospitalized patients: potential implications for care[J]. Am Heart J, 2021, 241: 59-67. DOI: 10.1016/j.ahj.2021.07.006.
    [10] RAEBEL MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers[J]. Cardiovasc Ther, 2012, 30(3): e156-e166. DOI: 10.1111/j.1755-5922.2010.00258.x.
    [11] ALMALKI B, CUNNINGHAM K, KAPUGI M, et al. Management of hyperkalemia: a focus on kidney transplant recipients[J]. Transplant Rev (Orlando), 2021, 35(2): 100611. DOI: 10.1016/j.trre.2021.100611.
    [12] RIZK JG, LAZO JG JR, QUAN D, et al. Mechanisms and management of drug-induced hyperkalemia in kidney transplant patients[J]. Rev Endocr Metab Disord, 2021, 22(4): 1157-1170. DOI: 10.1007/s11154-021-09677-7.
    [13] BUSSALINO E, PANARO L, MARSANO L, et al. Prevalence and clinical correlates of hyperkalemia in stable kidney transplant recipients[J]. Intern Emerg Med, 2021, 16(7): 1787-1792. DOI: 10.1007/s11739-021-02649-4.
    [14] PARK S, KANG E, PARK S, et al. Metabolic acidosis and long-term clinical outcomes in kidney transplant recipients[J]. J Am Soc Nephrol, 2017, 28(6): 1886-1897. DOI: 10.1681/ASN.2016070793.
    [15] POCHINENI V, RONDON-BERRIOS H. Electrolyte and acid-base disorders in the renal transplant recipient[J]. Front Med (Lausanne), 2018, 5: 261. DOI: 10.3389/fmed.2018.00261.
    [16] LITTMANN L, GIBBS MA. Electrocardiographic manifestations of severe hyperkalemia[J]. J Electrocardiol, 2018, 51(5): 814-817. DOI: 10.1016/j.jelectrocard.2018.06.018.
    [17] 傅强, 付晓华, 李志樑, 等. 射血分数保留性心力衰竭合并终末期肾病不同透析方式下疗效对比[J]. 实用医学杂志, 2020, 36(23): 3222-3226. DOI: 10.3969/j.issn.1006-5725.2020.23.011.

    FU Q, FU XH, LI ZL, et al. Comparison of therapeutic effects of ESRD with HFpEF under different dialysis methods[J]. J Pract Med, 2020, 36(23): 3222-3226. DOI: 10.3969/j.issn.1006-5725.2020.23.011.
    [18] TEYMOURI N, MESBAH S, NAVABIAN SMH, et al. ECG frequency changes in potassium disorders: a narrative review[J]. Am J Cardiovasc Dis, 2022, 12(3): 112-124.
    [19] BOBBIO E, BOLLANO E, POLTE CL, et al. Association between central haemodynamics and renal function in advanced heart failure: a nationwide study from Sweden[J]. ESC Heart Fail, 2022, 9(4): 2654-2663. DOI: 10.1002/ehf2.13990.
    [20] CHEN JW, CHOU NK, WANG CH, et al. Impact of pretransplant renal replacement therapy on clinical outcome after isolated heart transplantation[J]. Transpl Int, 2022, 35: 10185. DOI: 10.3389/ti.2022.10185.
    [21] HONG KN, MERLO A, CHAUHAN D, et al. Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation[J]. J Heart Lung Transplant, 2016, 35(7): 893-900. DOI: 10.1016/j.healun.2016.02.003.
    [22] HUNTER RW, BAILEY MA. Hyperkalemia: pathophysiology, risk factors and consequences[J]. Nephrol Dial Transplant, 2019, 34(Suppl 3): iii2-iii11. DOI: 10.1093/ndt/gfz206.
    [23] WANG G, MA K, MA Z, et al. Short-term blood pressure variability and outcomes in non-dialysis chronic kidney disease[J]. Front Med (Lausanne), 2022, 9: 911205. DOI: 10.3389/fmed.2022.911205.
    [24] PATA R, LUTAYA I, MEFFORD M, et al. Urinary tract infection causing bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia (BRASH) syndrome: a case report and a brief review of the literature[J]. Cureus, 2022, 14(8): e27641. DOI: 10.7759/cureus.27641.
    [25] LINDNER G, BURDMANN EA, CLASE CM, et al. Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference[J]. Eur J Emerg Med, 2020, 27(5): 329-337. DOI: 10.1097/MEJ.0000000000000691.
    [26] PALMER BF. Potassium binders for hyperkalemia in chronic kidney disease-diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis[J]. Mayo Clin Proc, 2020, 95(2): 339-354. DOI: 10.1016/j.mayocp.2019.05.019.
    [27] GILLIGAN S, RAPHAEL KL. Hyperkalemia and hypokalemia in CKD: prevalence, risk factors, and clinical outcomes[J]. Adv Chronic Kidney Dis, 2017, 24(5): 315-318. DOI: 10.1053/j.ackd.2017.06.004.
    [28] LEON SJ, WHITLOCK R, RIGATTO C, et al. Hyperkalemia-related discontinuation of renin-angiotensin-aldosterone system inhibitors and clinical outcomes in CKD: a population-based cohort study[J]. Am J Kidney Dis, 2022, 80(2): 164-173. DOI: 10.1053/j.ajkd.2022.01.002.
    [29] SANTORO A, PERRONE V, GIACOMINI E, et al. Association between hyperkalemia, RAASi non-adherence and outcomes in chronic kidney disease[J]. J Nephrol, 2022, 35(2): 463-472. DOI: 10.1007/s40620-021-01070-6.
    [30] VOLTERRANI M, PERRONE V, SANGIORGI D, et al. Effects of hyperkalaemia and non-adherence to renin-angiotensin-aldosterone system inhibitor therapy in patients with heart failure in Italy: a propensity-matched study[J]. Eur J Heart Fail, 2020, 22(11): 2049-2055. DOI: 10.1002/ejhf.2024.
    [31] RICCIO E, CAPUANO I, BUONANNO P, et al. RAAS inhibitor prescription and hyperkalemia event in patients with chronic kidney disease: a single-center retrospective study[J]. Front Cardiovasc Med, 2022, 9: 824095. DOI: 10.3389/fcvm.2022.824095.
    [32] IMAMURA T, NARANG N, COMBS P, et al. Hyperkalemia in patients with left ventricular assist devices[J]. Circ Rep, 2021, 3(11): 647-653. DOI: 10.1253/circrep.CR-21-0078.
    [33] MEZZANO G, CÁRDENAS A, AGUILAR F, et al. Hyperkalemia influences the outcome of patients with cirrhosis with acute decompensation (AD) and acute-on-chronic liver failure (ACLF)[J]. Dig Liver Dis, 2021, 53(6): 738-745. DOI: 10.1016/j.dld.2020.12.009.
    [34] GRODZINSKY A, GOYAL A, GOSCH K, et al. Prevalence and prognosis of hyperkalemia in patients with acute myocardial infarction[J]. Am J Med, 2016, 129(8): 858-865. DOI: 10.1016/j.amjmed.2016.03.008.
    [35] GOYAL A, SPERTUS JA, GOSCH K, et al. Serum potassium levels and mortality in acute myocardial infarction[J]. JAMA, 2012, 307(2): 157-164. DOI: 10.1001/jama.2011.1967.
    [36] FISCHER B, SERRA A, TELSER H. Cost-effectiveness of treating patients with chronic kidney disease and prior hyperkalemia with renin-angiotensin-aldosterone system inhibitor and patiromer: a Swiss public healthcare perspective[J]. Adv Ther, 2022, 39(6): 2717-2730. DOI: 10.1007/s12325-022-02123-3.
    [37] WIDÉN J, IVARSSON M, SCHALIN L, et al. Cost-effectiveness analysis of patiromer in combination with renin-angiotensin-aldosterone system inhibitors for chronic kidney disease in Sweden[J]. Pharmacoeconomics, 2020, 38(7): 747-764. DOI: 10.1007/s40273-020-00902-w.
    [38] WARD T, BROWN T, LEWIS RD, et al. The cost effectiveness of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure in Ireland[J]. Pharmacoecon Open, 2022, 6(5): 757-771. DOI: 10.1007/s41669-022-00357-z.
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  245
  • HTML全文浏览量:  108
  • PDF下载量:  83
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-08-26
  • 网络出版日期:  2023-01-17
  • 刊出日期:  2023-01-15

目录

    /

    返回文章
    返回