背景:口服盐皮质激素受体拮抗剂未能证明其在急性心力衰竭中减充血和钾稳态的功效。静脉盐皮质激素受体拮抗剂尚未研究。
目的:本研究的目的是确认大剂量丹参酸钾联合经典利尿剂治疗急性心力衰竭的安全性。
方法:这项回顾性单中心研究纳入了2013年至2018年间因急性心力衰竭住院的连续患者。包括来自CARRESS-HF试验的标准利尿剂方案治疗的一百名超负荷患者。入院时没有与肌酐或钾血症相关的排除标准。根据丹瑞酸钾病位构成两组:低剂量组(<300mg/d)和高剂量组(≥300mg/d);两组在基线特征方面相似。
结果:低剂量组和高剂量组的平均每日丹瑞酸钾剂量分别为198mg/天(范围为100-280mg/天)和360mg/天(范围为300-600mg/天)。高剂量组和低剂量组在死亡率方面没有显著差异,透析,肾功能,高钾血症,出血,败血症或混乱。
结论:高剂量的丹瑞酸钾可以安全地与标准利尿剂联合用于急性心力衰竭,即使是肾功能改变的患者。需要进行一项前瞻性研究来评估高剂量丹参酸钾在预防低钾血症和改善充血方面的功效。
BACKGROUND: Oral mineralocorticoid receptor antagonists have failed to prove their efficacy for decongestion and potassium homeostasis in acute heart failure. Intravenous mineralocorticoid receptor antagonists have yet to be studied.
OBJECTIVE: The aim of this study was to confirm the safety of high-dose potassium canrenoate in association with classic diuretics in acute heart failure.
METHODS: This retrospective single-centre study included consecutive patients who were hospitalized with acute heart failure between 2013 and 2018. One hundred patients with overload treated with the standardized diuretic protocol from the CARRESS-HF trial were included. There were no exclusion criteria relating to creatinine or kalaemia at the time of admission. Two groups were constituted on the basis of potassium canrenoate posology: a low-dose group (<300mg/day) and a high-dose group (≥300mg/day); the groups were similar in terms of baseline characteristics.
RESULTS: Mean daily potassium canrenoate doses were 198mg/day (range 100-280mg/day) in the low-dose group and 360mg/day (range 300-600mg/day) in the high-dose group. There was no significant difference between the high-dose and low-dose groups in terms of mortality, dialysis, renal function, hyperkalaemia, haemorrhage, sepsis or confusion.
CONCLUSIONS: Potassium canrenoate at high doses can be used safely in association with standard diuretics in acute heart failure, even in patients with altered renal function. A prospective study is required to evaluate the efficacy of high-dose potassium canrenoate in preventing hypokalaemia and improving decongestion.