■研究慢性肾病患者高钾血症与长期心血管和肾脏预后之间的关系。
■使用日本医院索赔登记处进行了一项观察性回顾性队列研究,医疗数据愿景(2008年4月1日至2018年9月30日)。在1,208,894名患者中,至少有1次钾测量,根据国际疾病分类选择了167,465例慢性肾脏病患者,第十修订代码或估计肾小球滤过率(eGFR)小于60mL/min/1.73m2。高钾血症定义为在12个月内至少2次钾测量为5.1mmol/L或更高。正常血钾对照组是没有记录钾水平为5.1mmol/L或更高和3.5mmol/L或更低的患者。eGFR和死亡危险比的变化,因心脏事件住院,心力衰竭,在倾向评分匹配的高钾血症患者和正常钾血对照组之间评估了肾脏替代治疗的引入。
■在符合分析条件的16,133名高钾血症患者和11,898名正钾血症对照者中,在倾向评分匹配后,选择了5859例(36.3%)患者和5859例(49.2%)对照。平均随访期为3.5年。患者和对照组的3年eGFR变化分别为-5.75和-1.79mL/min/1.73m2。总的来说,高钾血症患者的死亡风险较高,因心脏事件住院,心力衰竭,和肾脏替代疗法的引入比对照组,风险比为4.40(95%CI,3.74至5.18),1.95(95%CI,1.59至2.39),5.09(95%CI,4.17至6.21),和7.54(95%CI,5.73至9.91),分别。
■高钾血症与死亡和不良临床结局的显著风险相关,肾功能下降更快。这些发现强调了高钾血症作为慢性肾脏病患者未来不良事件的易感性的重要性。
UNASSIGNED: To examine the association between hyperkalemia and long-term cardiovascular and renal outcomes in patients with chronic kidney disease.
UNASSIGNED: An observational retrospective cohort study was performed using a Japanese hospital claims registry, Medical Data Vision (April 1, 2008, to September 30, 2018). Of 1,208,894 patients with at least 1 potassium measurement, 167,465 patients with chronic kidney disease were selected based on International Classification of Diseases, Tenth Revision codes or estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Hyperkalemia was defined as at least 2 potassium measurements of 5.1 mmol/L or greater within 12 months. Normokalemic controls were patients without a record of potassium levels of 5.1 mmol/L or greater and 3.5 mmol/L or less. Changes in eGFRs and hazard ratios of death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction were assessed between propensity score-matched hyperkalemic patients and normokalemic controls.
UNASSIGNED: Of 16,133 hyperkalemic patients and 11,898 normokalemic controls eligible for analyses, 5859 (36.3%) patients and 5859 (49.2%) controls were selected after propensity score matching. The mean follow-up period was 3.5 years. The 3-year eGFR change in patients and controls was -5.75 and -1.79 mL/min/1.73 m2, respectively. Overall, hyperkalemic patients had higher risks for death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction than controls, with hazard ratios of 4.40 (95% CI, 3.74 to 5.18), 1.95 (95% CI, 1.59 to 2.39), 5.09 (95% CI, 4.17 to 6.21), and 7.54 (95% CI, 5.73 to 9.91), respectively.
UNASSIGNED: Hyperkalemia was associated with significant risks for mortality and adverse clinical outcomes, with more rapid decline of renal function. These findings underscore the significance of hyperkalemia as a predisposition to future adverse events in patients with chronic kidney disease.