温血高钾间断灌注心肌保护的临床应用

目的　探讨浅低温体外循环 (CPB)温血间断灌注心肌保护的临床效果。方法　全组随机分为对照组 (A组 )6 8例 ,采用浅低温CPB温血高钾持续灌注心肌保护。实验组 (B组 ) 91例 ,采用浅低温CPB温血高钾间断灌注心肌保护。观察两组术中心肌保护效果的差别。结果　CPB时间、主动脉阻断时间B组明显小于A组 (P <0 .0 5 ) ;库血用量和 2 4h胸腔引流量B组明显少于A组 (P <0 .0 5 ) ;主动脉开放前血钾浓度B组明显低于A组 (P <0 .0 5 ) ;主动脉开放后心脏自动复跳率B组明显高于A组 (P <0 .0 5 ) ;术后心功能临床观察两组无显著差异。结论　浅低温CPB温血高钾间断灌注保护心肌效果良好。     

SCNN1B基因突变致全身型假性醛固酮减少症1型1例报告并文献复习

目的探讨SCNN1B基因突变所致的全身型假性醛固酮减少症1型(PHA1)的早期诊断和治疗。方法回顾分析1例PHA1患儿的临床资料,并对全身型PHA1尤其是SCNN1B基因突变的全身型PHA1进行文献复习。结果患儿,女,4岁3个月,出生1个月时诊断为假性醛固酮减少症,服用聚苯乙烯磺酸钙、枸橼酸钠后仍反复出现脱水性休克、低钠血症、高钾血症、酸中毒,且反复下呼吸道感染及皮疹。基因测序显示SCNN1B基因编码区第2外显子存在c.118CT错义突变,第4内含子存在c.776+1GA错义突变。查询HGMD数据库、ESP6500siv2_ALL、千人基因组(1000g2015aug_ALL)和dbSNP 147数据库,两种突变均未见报道。未检测到高IgE综合征相关的基因突变。目前国内无SCNN1B突变致全身型PHA1病例报道。国外报道4例,发病年龄为出生3天～3周,表现为呕吐、反应差、休克、脱水、高血钾、低血钠、代谢性酸中毒、流清涕、反复下呼吸道感染,4例中1例死亡。结论 SCNN1B突变所致PHA1较罕见,为常染色隐性遗传,新生儿顽固性低钠血症、高钾血症和代谢性酸中毒应考虑PHA1可能,基因检测可明确诊断及判断预后。     

血液透析患者高钾血症季节分布特征研究北大核心CSCD

目的分析血液透析患者高钾血症的发生率及其季节分布特征和不同检测次数的高钾检出率,为高钾血症的防治及研究提供重要参考依据。方法纳入四川省2018年至2020年血液透析患者资料,以血钾≥5.0 mmol/L定义为高钾血症,计算高钾血症发生率及时间分布特征。结果(1)共纳入6618例至少有一次血钾检测记录的患者,包含24885次血钾结果,高钾血症发生率为28.2%。(2)第一至第四季度高钾血症发生率分别为30.9%、29.2%、23.7%、28.6%。(3)血钾检测次数越多,高钾血症检出率越高。结论血液透析患者高钾血症发生率较高,存在季节差异,增加检测频率可以显著增加高钾血症患者检出率。     

Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function

Background and objectives

Patients with CKD are more likely than others to have abnormalities in serum potassium (K⁺). Aside from severe hyperkalemia, the clinical significance of K⁺ abnormalities is not known. We sought to examine the association of serum K⁺ with mortality and hospitalization rates within narrow eGFR strata to understand how the burden of hyperkalemia varies by CKD severity. Associations were examined between serum K⁺ and discontinuation of medications that block the renin-angiotensin-aldosterone system (RAAS), which are known to increase serum K⁺.

Design, setting, participants, & measurements

A cohort of patients with CKD (eGFR<60 ml/min per 1.73 m²) with serum K⁺ data were studied (n=55,266) between January 1, 2009, and June 30, 2013 (study end). Serum K⁺, eGFR, and covariates were considered on a time-updated basis. Mortality, major adverse cardiovascular events (MACE), hospitalization, and discontinuation of RAAS blockers were considered per time at risk.

Results

During the study, serum K⁺ levels of 5.5–5.9 and ≥6.0 mEq/L were most prevalent at lower eGFR: they were present, respectively, in 1.7% and 0.2% of patient-time for eGFR of 50–59 ml/min per 1.73 m² versus 7.6% and 1.8% of patient-time for eGFR<30 ml/min per 1.73 m². Serum K⁺ level <3.5 mEq/L was present in 1.2%–1.4% of patient-time across eGFR strata. The median follow-up time was 2.76 years. There was a U-shaped association between serum K⁺ and mortality; pooled adjusted incidence rate ratios were 3.05 (95% confidence interval, 2.53 to 3.68) and 3.31 (95% confidence interval, 2.52 to 4.34) for K⁺ levels <3.5 mEq/L and ≥6.0 mEq/L, respectively. Within eGFR strata, there were U-shaped associations of serum K⁺ with rates of MACE, hospitalization, and discontinuation of RAAS blockers.

Conclusions

Both hyperkalemia and hypokalemia were independently associated with higher rates of death, MACE, hospitalization, and discontinuation of RAAS blockers in patients with CKD who were not undergoing dialysis. Future studies are needed to determine whether interventions targeted at maintaining normal serum K⁺ improve outcomes in this population.     

U Wave Variability in the Surface ECG

A 72‐year‐old man with heart failure, left ventricular dysfunction (ejection fraction 20%), prior ischemic stroke, COPD, and exacerbation of chronic renal failure was admitted in our unit. Serum potassium was 6.1 mmol/L, calcium concentration was at the lower normal range 2.15 mmol/L, and NT‐pro‐BNP was 28,900 pg/mL. The surface 12‐lead electrocardiogram (ECG) showed sinus rhythm at 60 bpm, PR interval 160 ms, QRS duration 115 ms, QT interval 460 ms, and left ventricular hypertrophy criteria. Negative T waves in leads I, II, aVL, and V₄–V₆ were also seen. In leads V₄–V₆, negative U waves were observed in concordance with negative T waves. In all precordial leads, beat‐to‐beat U‐wave polarity variability was observed as a polarity variation from negative to positive with associated and stable negative T waves, in a beat‐to‐beat alternate morphology.     

Community-acquired hyperkalemia in elderly patients: risk factors and clinical outcomes

Background: Although the risk and related factors of hyperkalemia developed in the hospital are known in elderly, risk and related factors of community-acquired hyperkalemia (CAH) in this population are not well known. This study was performed to investigate the risk of CAH in elderly and evaluate the related factors and clinical outcomes.

Study design, setting and participants, intervention: Patients (aged ≥65 years) with hyperkalemia were screened. Group 1 (young-old); 65–74 years/old, Group 2 (middle-old); 75–84 years/old, Group 3 (oldest-old); ≥85 years/old, and Group 4 (control group); ≥65 years/old (normal serum potassium levels). The relation between CAH and hospital expenses (HE), the number of comorbid diseases (NCD), and all-cause of mortality rates (MR) were evaluated. We also investigated whether drugs, sex, and NCD are risk factors for the development of CAH.

Results: There was a positive correlation between serum potassium levels and length of hospital stay, MR, HE, and NCD (p?<?0.001). Risk factors for CAH were the use of non-steroidal-anti inflammatory drugs (NSAIDs) (Odds Ratio [OR]: 2.679), spironolactone (OR: 2.530), and angiotensin converting enzyme inhibitors (ACEI) (OR: 2.242), angiotensin receptor blockers (ARB) (OR: 2.679), ≥2 comorbid diseases (OR: 2.221), female gender (OR: 2.112), and renal injury (OR: 5.55). CAH risk was found to be increased 30.03 times when any of ACEI, ARB, NSAIDs, or spironolactone is given to a patient with a renal injury.

Conclusion: Use of NSAIDs, ACEI, ARB, spironolactone and increased NCD are all independent risk factors for CAH in the elderly, especially in patients with kidney diseases.