贝那普利和氯沙坦对血液透析患者血钾的影响

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者单独或联合应用贝那普利和氯沙坦对血钾的影响。方法 44例MHD患者为研究对象,透析前血钾6.0mmol/L。随机分为A、B两组,于观察起始及1月后A组患者依次加用贝那普利(10mg qd)和氯沙坦(50mg qd),B组患者依次加用氯沙坦和贝那普利,其他用药不变,观察3个月。检测用药前、用药后1个月、2个月、3个月的透析前血钾水平,用药前和用药后3个月清晨透析前平卧位血清醛固酮水平。应用独立样本t检验,方差分析和x2方检验分析相关结果。结果用药前、单独应用贝那普利或氯沙坦以及联合应用贝那普利和氯沙坦血钾水平及高钾血症发生率差异无统计学意义(P0.05);用药后患者血清醛固酮水平较用药前明显下降(P=0.016)。结论 MHD患者单独或联合应用贝那普利及氯沙坦对血钾水平及高钾血症的发生率无显著影响。

The effect of Benazepril and Losartan on serum potassium level in hemodialysis patients

Objective To evaluate the effect of either combination therapy of Benazepril and Losartan or monotherapy of Benazepril or Losartan on serum potassium level in maintenance hemodialysis patients. Methods Forty-four hemodialysis patients with pre-dialytic serum potassium level lower than 6.0mmol/l were recruited. Patients were randomized into group A or group B. In group A, Benazepril （10mg q.d.） and Losartan （50mg q.d.） were sequentially added to the patients at the beginning and one month later. In group B, Losartan and Benazepril were sequentially added to the patients. Other medications remained unchanged. Serum potassium levels were measured at the beginning and 1, 2 and 3 months after start of the treatment. Fasting blood samples were collected in the morning at supine position, and serum aldosterone was measured by radioimmunoassay. Data were analyzed by t-test, analysis of variance test, or chi-square test to compare serum potassium level and the prevalence of hyperkalemia. Results There was no significant change in serum potassium level during the period of study in each group, nor was the prevalence of hyperkalemia; Serum aldosterone levels decreased significantly after the treatment （P=0.016）. Conclusions Monotherapy of Benazepril or Losartan or combination therapy of Benazepril and Losartan are not associated with the higher prevalence of hyperkalemia in maintenance hemodialysis patients.