<br>慢性肾病患者慢性高钾血症的治疗：新闻选项的老问题,Frontiers in Medicine

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慢性肾病患者慢性高钾血症的治疗：新闻选项的老问题
Frontiers in Medicine ( IF 3.1 ) Pub Date : 2021-05-04 , DOI: 10.3389/fmed.2021.653634
Enrique Morales _{1,

2,

3} , Paolo Cravedi ₄ , Joaquin Manrique _{5,

6}

Affiliation

高钾血症是慢性肾脏病（CKD）患者主要的电解质紊乱之一。随着肾小球滤过率（GFR）下降，高钾血症的患病率增加。尽管慢性高钾血症不是医疗紧急情况，但从中长期来看，它可能会对适当的心肾管理产生负面影响。高钾血症在服用肾素-血管紧张素-醛固酮系统抑制剂 (RAASi) 或盐皮质激素受体拮抗剂 (MRA) 的患者中很常见，并且可能影响高血压、糖尿病、心力衰竭 (HF) 和 CKD 的治疗优化。与完全服用 RAASi 剂量相比，慢性肾病 (CKD)、糖尿病或心力衰竭 (HF) 患者中次优剂量的死亡率更高，并且在停止 RAASi 的患者中死亡率最高。慢性高钾血症的治疗仍然具有挑战性。因此，在现实世界中，停止或减少 RAASi 治疗可能会导致不良的心肾结局，而目前的指南对于 RAASi 治疗增强心脏和肾脏保护作用的建议有所不同。自 50 多年前引入阳离子交换树脂以来，高钾血症的治疗方案没有太大变化。如今，两种新型钾结合剂 Patiromer Sorbitex Calcium 和环硅酸锆钠 (SZC) 已获得 FDA 和欧洲药品管理局的批准，已证明其在降低血清钾方面的临床功效和良好的安全性。使用新型钾结合剂可以使高钾血症患者继续并优化 RAASi 治疗，从而保持 CKD 和心血管疾病患者的心肾保护作用。然而，需要进一步研究来解决与钾失调相关的一些问题（慢性高钾血症的定义、监测策略、高钾血症的预测评分或治疗时间）。

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Management of Chronic Hyperkalemia in Patients with Chronic Kidney Disease: an old problem with news options

Hyperkalemia is one of the main electrolyte disorders in patients with chronic kidney disease (CKD). The prevalence of hyperkalemia increases as the Glomerular Filtration Rate (GFR) declines. Although chronic hyperkalemia is not a medical emergency, it can have negative consequences for the adequate cardio-renal management in the medium and long term. Hyperkalemia is common in patients on renin-angiotensin-aldosterone system inhibitors (RAASi) or Mineralocorticoid Receptor Antagonists (MRAs) and can affect treatment optimization for hypertension, diabetes mellitus, heart failure (HF) and CKD. Mortality rates are higher with suboptimal dosing among patients with CKD, diabetes or HF compared with full RAASi dosing, and are the highest among patients who discontinue RAASis. The treatment of chronic hyperkalemia is still challenging. Therefore, in the real world, discontinuation or reduction of RAASi therapy may lead to adverse cardiorenal outcomes, and current guidelines differ with regard to recommendations on RAASi therapy to enhance cardio and reno-protective effects. Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin over 50 years ago. Nowadays, two new potassium binders, Patiromer Sorbitex Calcium and Sodium Zirconium Cyclosilicate (SZC) already approved by FDA and by the European Medicines Agency, have demonstrated their clinical efficacy in reducing serum potassium with a good safety profile. The use of the newer potassium binders may allow continuing and optimizing RAASi therapy in patients with hyperkalemia keeping the cardio-renal protective effect in patients with CKD and cardiovascular disease. However, further research is needed to address some questions related to potassium disorders (definition of chronic hyperkalemia, monitoring strategies, prediction score for hyperkalemia or length for treatment).

更新日期：2021-05-04

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