Abstract：
OBJECTIVE: To explore the relationship between dietary fiber (DF) intake and hyperkalemia in maintenance hemodialysis (MHD) patients.
METHODS: A total of 110 MHD patients were included, including 67 males and 43 females. Patients were divided into normal serum potassium group (N) and a hyperkalemia group (H) according to the serum potassium level before dialysis. The daily diet was recorded by the 3-day dietary recording method. The daily dietary nutrient intake of patients was analyzed. Logistic regression was used to analyze the relationship between hyperkalemia and DF intake. A receiver operating characteristic curve was used to analyze the cutoff value of DF intake to prevent hyperkalemia.
RESULTS: Of the 110 patients, 38 had hyperkalemia (serum potassium >5.5 mmol/L) before dialysis. There was no difference in sex, residual kidney function, body mass index, energy intake, fat intake, protein intake, calcium intake, sodium intake, phosphorus intake or the administration history of potassium-lowering drugs between the 2 groups (P > .05). Compared with the H group, patients in the N group had higher carbohydrate intake (315 ± 76 g/d vs. 279 ± 66 g/d, P = .016), dietary fiber intake (19 ± 5 g/d vs. 12 ± 8 g/d, P < .0001), and potassium intake (1,698 ± 392 mg/d vs. 1,533 ± 413 mg/d, P = .041), and more patients in group N used renin-angiotensin-aldosterone system inhibitors (52.78% vs. 23.68%, P = .003). However, the number of patients with constipation in group N was less than that in group H (20.83% vs. 42.11%, P = .018). Logistic regression analysis showed that DF intake was an independent protective factor for hyperkalemia [P < .0001, odds ratio = 0.766 (95% confidence intervals: 0.675-0.870)]. Receiver operating characteristic analysis showed that daily intake of DF greater than 15.33 g may be helpful to prevent hyperkalemia.
CONCLUSIONS: Insufficient dietary nutrient intake is prevalent in MHD patients, especially DF intake, which may be associated with hyperkalemia. Clinically, attention should be given to the dietary balance of MHD patients, especially DF intake.
METHODS: A total of 110 MHD patients were included, including 67 males and 43 females. Patients were divided into normal serum potassium group (N) and a hyperkalemia group (H) according to the serum potassium level before dialysis. The daily diet was recorded by the 3-day dietary recording method. The daily dietary nutrient intake of patients was analyzed. Logistic regression was used to analyze the relationship between hyperkalemia and DF intake. A receiver operating characteristic curve was used to analyze the cutoff value of DF intake to prevent hyperkalemia.
RESULTS: Of the 110 patients, 38 had hyperkalemia (serum potassium >5.5 mmol/L) before dialysis. There was no difference in sex, residual kidney function, body mass index, energy intake, fat intake, protein intake, calcium intake, sodium intake, phosphorus intake or the administration history of potassium-lowering drugs between the 2 groups (P > .05). Compared with the H group, patients in the N group had higher carbohydrate intake (315 ± 76 g/d vs. 279 ± 66 g/d, P = .016), dietary fiber intake (19 ± 5 g/d vs. 12 ± 8 g/d, P < .0001), and potassium intake (1,698 ± 392 mg/d vs. 1,533 ± 413 mg/d, P = .041), and more patients in group N used renin-angiotensin-aldosterone system inhibitors (52.78% vs. 23.68%, P = .003). However, the number of patients with constipation in group N was less than that in group H (20.83% vs. 42.11%, P = .018). Logistic regression analysis showed that DF intake was an independent protective factor for hyperkalemia [P < .0001, odds ratio = 0.766 (95% confidence intervals: 0.675-0.870)]. Receiver operating characteristic analysis showed that daily intake of DF greater than 15.33 g may be helpful to prevent hyperkalemia.
CONCLUSIONS: Insufficient dietary nutrient intake is prevalent in MHD patients, especially DF intake, which may be associated with hyperkalemia. Clinically, attention should be given to the dietary balance of MHD patients, especially DF intake.
摘要：
目的：探讨维持性血液透析(MHD)患者膳食纤维(DF)摄入与高钾血症的关系。
方法：共纳入110例MHD患者，其中男性67人，女性43人。根据透析前的血清钾水平将患者分为正常血清钾组（N）和高钾血症组（H）。通过3天饮食记录方法记录每日饮食。分析患者每日膳食营养素摄入量。采用Logistic回归分析高钾血症与DF摄入的关系。使用受试者工作特征（ROC）曲线分析DF摄入量以预防高钾血症的临界值。
结果：在110名患者中，38例透析前出现高钾血症（血清钾>5.5mmol/L）。性别没有差异，残余肾功能，体重指数（BMI），能量摄入，脂肪摄入量，蛋白质摄入量，钙摄入量，钠摄入量，两组之间的磷摄入量或降钾药物的给药史（p>0.05）。与H组比拟，N组患者碳水化合物摄入量较高（315±76g/d与279±66g/d,p=0.016),膳食纤维摄入量(19±5g/dvs.12±8g/d，p<0.0001）和钾摄入量（1698±392mg/d与1533±413mg/d，p=0.041),N组中更多患者使用肾素-血管紧张素-醛固酮系统抑制剂（52.78％vs.23.68%,p=0.003)。然而,N组便秘患者数量少于H组（20.83%vs.42.11%,p=0.018)。Logistic回归分析显示DF摄入是高钾血症的独立保护因素[p<0.0001,OR=0.766(95%CI:0.675～0.870)]。ROC分析显示每日摄入大于15.33g的DF可能有助于预防高钾血症。
结论：在MHD患者中普遍存在膳食营养素摄入不足，尤其是DF的摄入量，这可能与高钾血症有关。临床上,应注意MHD患者的饮食平衡，尤其是DF摄入量。
方法：共纳入110例MHD患者，其中男性67人，女性43人。根据透析前的血清钾水平将患者分为正常血清钾组（N）和高钾血症组（H）。通过3天饮食记录方法记录每日饮食。分析患者每日膳食营养素摄入量。采用Logistic回归分析高钾血症与DF摄入的关系。使用受试者工作特征（ROC）曲线分析DF摄入量以预防高钾血症的临界值。
结果：在110名患者中，38例透析前出现高钾血症（血清钾>5.5mmol/L）。性别没有差异，残余肾功能，体重指数（BMI），能量摄入，脂肪摄入量，蛋白质摄入量，钙摄入量，钠摄入量，两组之间的磷摄入量或降钾药物的给药史（p>0.05）。与H组比拟，N组患者碳水化合物摄入量较高（315±76g/d与279±66g/d,p=0.016),膳食纤维摄入量(19±5g/dvs.12±8g/d，p<0.0001）和钾摄入量（1698±392mg/d与1533±413mg/d，p=0.041),N组中更多患者使用肾素-血管紧张素-醛固酮系统抑制剂（52.78％vs.23.68%,p=0.003)。然而,N组便秘患者数量少于H组（20.83%vs.42.11%,p=0.018)。Logistic回归分析显示DF摄入是高钾血症的独立保护因素[p<0.0001,OR=0.766(95%CI:0.675～0.870)]。ROC分析显示每日摄入大于15.33g的DF可能有助于预防高钾血症。
结论：在MHD患者中普遍存在膳食营养素摄入不足，尤其是DF的摄入量，这可能与高钾血症有关。临床上,应注意MHD患者的饮食平衡，尤其是DF摄入量。
