Nefroloji Polikliniği’nde Hiperpotasemi Saptanan Hastaların Klinik ve Laboratuvar Özellikleri

Yıl 2021, Cilt: 11 Sayı: 1, 76 - 81, 01.04.2021

Didem Eroğlu Divriklioğlu Erkan Şengül

Öz

Amaç: Bu çalışmanın amacı, nefroloji polikliniğine başvuran hastalarda hiperpotasemi prevalansını saptamak, hiperpotasemi ile hastaların demografik özellikleri, kullanmakta oldukları ilaçlar ve ek hastalıklar arasındaki ilişkiyi incelemektir.
Materyal ve Metot: Çalışmaya 1 Ocak 2016-30 Haziran 2016 tarihleri arasında Nefroloji Polikliniğine başvuran, serum örneklerinde potasyum değeri 5,1 mEq/L ve üzerinde olan ve renal replasman tedavisi almayan 388 hasta alındı. Hastaların cinsiyeti, yaşı, kan basıncı, ek hastalıkları, kullandıkları ilaçlar, biyokimyasal tetkikler, 24 saatlik idrarda total protein ve albumin düzeyleri, daha önceki atak sayıları ve uygulanan tedaviler incelendi. İstatistiksel analiz bilgisayarda SPSS ver.17.0 programı kullanılarak gerçekleştirildi.
Bulgular: Çalışmaya alınan hastaların 212'si (%54,6) kadın, 176'sı (%45,4) erkekti. Hastaların yaş ortalaması 65,76±12,9 yıl olarak bulundu. Hiperpotasemi prevalansı %15,9 ve ortalama potasyum düzeyi 5,49±0,36 mEq/L tespit edildi. Hastaların %57'sinde hafif, %31,5'inde orta, %11,5'inde ciddi hiperpotasemi saptandı. Çalışmaya alınan 293 hastada (%75,5) anjiotensin dönüştürücü enzim inhibitörü (ACEİ) veya anjiotensin reseptör blokeri (ARB) kullanımı; 36 hastada (%9,3) ACEİ veya ARB ile birlikte spironolakton kullanımı; 147 hastada (%37,9) beta bloker kullanımı mevcuttu. Hastaların %85,5'inde kronik böbrek hastalığı (KBH) ve %56,2'sinde diyabetes mellitus olduğu saptandı. Hiperpotasemisi olan 13 (%3,4) hastaya acil tedavi uygulandı. Acil hemodiyaliz ihtiyacı olmadı. Analizlerde; serum potasyum düzeyinin ACEİ veya ARB ile birlikte spironolakton kullanan hastalarda, kullanmayanlara göre anlamlı olarak daha yüksek olduğu tespit edildi (p=0,001).
Sonuç: Özellikle KBH varlığında renin anjiotensin aldosteron sistem inhibitörü ilaçların birlikte kullanımının hiperpotasemi gelişme riskini arttırdığı göz önüne alınıp hastaların bu açıdan takip edilmesi gerekmektedir.

Anahtar Kelimeler

Hiperpotasemi, etiyoloji, kronik böbrek hastalığı

Clinical and Laboratory Features of Patients with Hyperpotasemia in Nephrology Outpatient Clinic

Öz

Aim: The objective of this study is to determine the prevalence of hyperkalemia in patients admitted to nephrology outpatient clinic, to investigate the relationship between hyperkalemia and demographic characteristics of patients, comorbidities and drugs.
Material and Method: 388 patients admitted to Nephrology Outpatient Clinic between 1 January 2016 and 30 June 2016 and whose serum potassium value is ≥5.1 mEq/L and without renal replacement therapy were included in the study. Patient’s gender, age, blood pressure, comorbidities, drugs, biochemical examination, total protein and albumin in 24 hour urine collection, the number of previous attacks and treatment approaches were examined. Statistical analysis was performed with using SPSS ver. 17.0 program.
Results: Patients included in this study were consist of 212 (54.6%) female and 176 (45.4%) male. The average age of the patients was 65.76±12.09 years. The prevalence of hyperkalemia was 15.9% and the average potassium level was 5.49±0.36 mEq/L. When hyperkalemic patients were categorized into groups, 57 % had mild, 31.5% had moderate and 11.5% had severe hyperkalemia. In our study, there was 293 patients (75.5%) using angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), 36 patients (9.3%) using spironolactone with ACEI or ARB, and 147 patients (37.9%) using beta blockers. It was shown that 85.5 % of the patients had chronic kidney disease (CKD) and 56.2% had diabetes mellitus. Thirteen patients (3.4%) with hyperkalemia underwent emergency treatment. There was no patient needed urgent hemodialysis. Significant differences were found between those who did or did not use spironolactone combination therapy with ACEI or ARB (p=0.001).
Conclusion: Particularly in CKD patients, the use of a combination of renin angiotensin aldosterone system inhibitors increases the risk of developing hyperkalemia, and patients should be monitored in this respect.

Anahtar Kelimeler

Hyperkalemia, etiology, chronic kidney disease

Kaynakça

• 1. Weiner ID, Linas SL, Wingo CS. Disorders of Potassium Metabolism In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comphrehensive Clinical Nephrology. 6th ed. Elsevier; 2019. p. 111-23.
• 2. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130(6):461-70.
• 3. Motta D, Ceasno G, Pignatora A, Boero R. Severe hyperkalemia in patients referred to an emergency departement: the role of antialdosterone drugs and of renin-angiotensin system blockers. G. Ital Nefrol 2017;34: 1.
• 4. Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol 2010;5(3):531-48.
• 5. Bakris GL, Siomos M, Richardson D, Janssen I, Bolton WK, Hebert L, et al. ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. VAL-K Study Group. Kidney Int 2000;58(5):2084-92.
• 6. Ahuja TS, Freeman D Jr, Mahnken JD, Agraharkar M, Siddiqui M, Memon A. Predictors of the development of hyperkalemia in patients using angiotensin-converting enzyme inhibitors. Am J Nephrol 2000;20(4):268-72.
• 7. Sica DA. Mineralocorticoid Receptor Antagonists for Treatment of Hypertension and Heart Failure. Methodist Debakey Cardiovasc J 2015;11(4):235-9.
• 8. Cruz CS, Cruz LS, Silva GR, Marcílio de Souza CA. Incidence and predictors of development of acute renal failure related to treatment of congestive heart failure with ACE inhibitors. Nephron Clin Pract 2007;105(2):77-83.
• 9. Reardon LC, Macpherson DS. Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors. How much should we worry? Arch Intern Med 1998;158(1):26-32.
• 10. Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders. Am J Med 2000;109(4):307-14.
• 11. Desai A. Hyperkalemia associated with inhibitors of the renin-angiotensin-aldosterone system: balancing risk and benefit. Circulation 2008;118(16):1609-11.
• 12. DuBose TD Jr. Hyperkalemic hyperchloremic metabolic acidosis: pathophysiologic insights. Kidney Int 1997;51(2):591-602.
• 13. Moranne O, Froissart M, Rossert J, Gauci C, Boffa JJ, Haymann JP, et al. NephroTest Study Group. Timing of onset of CKD-related metabolic complications. J Am Soc Nephrol 2009;20(1):164-71.
• 14. Drawz PE, Babineau DC, Rahman M. Metabolic complications in elderly adults with chronic kidney disease. J Am Geriatr Soc 2012;60(2):310-5.
• 15. Loutradis C, Tolika P, Skodra A, Avdelidou A, Sarafidis PA. Prevalence of Hyperkalemia in Diabetic and Non-Diabetic Patients with Chronic Kidney Disease: A Nested Case-Control Study. Am J Nephrol 2015;42(5):351-60.
• 16. Desai AS, Swedberg K, McMurray JJ, Granger CB, Yusuf S, Young JB, et al. CHARM Program Investigators. Incidence and predictors of hyperkalemia in patients with heart failure: an analysis of the CHARM Program. J Am Coll Cardiol 2007;50(20):1959-66.
• 17. Perazella MA, Mahnensmith RL. Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis. J Gen Intern Med 1997;12(10):646-56.
• 18. Acker CG, Johnson JP, Palevsky PM, Greenberg A. Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch Intern Med 1998;158(8):917-24.