| BackgroundHyperkalemia is a common complication in patients with chronic kidney disease.For patients with chronic kidney disease,the prevention and timely treatment of hyperkalemia are very important.The current clinical measures commonly used to treat hyperkalemia includes intravenous infusion drugs,sodium polystyrene sulfonate,and emergency hemodialysis treatment.But these measures have their own disadvantages.Sodium zirconium cyclosilicate is a non-absorbable zirconium silicate that combines with potassium in the gastrointestinal tract and is excreted in the feces to reduce the concentration of free potassium ions,thereby reducing blood potassium levels.At the same time,sodium zirconium cyclosilicate is a highly selective cation exchanger.Its micropore size and composition have a high affinity for potassium.It can capture potassium in the intestine to exchange sodium and hydrogen,and it is effective in the entire digestive tract.It can start capturing potassium ions from the stomach and duodenum.As a new drug marketed in China,it is necessary to observe the clinical efficacy of sodium zirconium cyclosilicate powder in reducing potassium in patients with chronic kidney disease and hyperkalemia.PurposeTo investigate the efficacy of sodium zirconium cyclosilicate on emergency correction of hyperkalemia in chronic kidney disease patients.MethodsUsing retrospective analysis,Patients with chronic kidney disease who were admitted to the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from May 2020 to December 2020 were selected.Patients who had hyperkalemia and took sodium zirconium cyclosilicate powder were finally included.And patients who had hyperkalemia received intravenous infusion to reduce potassium were also included.Inclusion criteria(1)Patients diagnosed with chronic kidney disease;(2)18-80 years old,no gender limit;(3)Serum potassium was higher than the upper limit of normal but lower than 7.2mmol/L at the time of admission.Exclusion criteria(1)Patients who are pregnant or breastfeeding;(2)Patients who need emergency dialysis:①Hyperkalemia that cannot be controlled by drugs;②Acidosis that cannot be controlled by drugs,in which PH<7.2,HCO3-≤10mmol/L;③Retention of water and sodium that cannot be controlled by drugs;④Complicated with pericarditis,gastrointestinal bleeding and central nervous system symptoms;⑤Drug poisoning or severe poisoning leads to respiratory failure,heart failure,hypotension,hypothermia,mental disturbance,and the condition continues to deteriorate after active rescue or medical treatment is ineffective;(3)Patients with gastrointestinal diseases or unable to eat normally;(4)Patients with progressive cardiovascular disease with severe clinical manifestations.(5)Patients with hypertension who are difficult to control with drugs.(6)Incomplete medical records or unclear medical history.The general information collected from patients includes:age,gender,medical history and combined medication,height,weight,heart rate,blood pressure.Collect routine blood tests(including hemoglobin,white blood cell count and platelet count),blood biochemistry(including creatinine,uric acid,urea nitrogen,glomerular filtration rate,total protein,albumin,fasting blood glucose,total cholesterol,and glycerin)at admission.Triester,low-density lipoprotein,high-density lipoprotein,B-type natriuretic peptide,glycosylated hemoglobin),blood potassium,calcium,phosphorus,magnesium,sodium,chlorine,carbon dioxide and other related indicators before and after the patient’s medication.Record the symptoms of hypokalemia,edema,constipation,and diarrhea that occurred during the medication;any unpleasant signs related to the time of receiving medication or not related to the purpose of medication(including abnormal laboratory test results),symptoms or disease.Results(1)The general situation of the patient:A total of 37 cases were included in the observation group.The average duration of the disease was 730(285,3103)days.Among them,there were 26 males and 11 females,with an average age of 52(35.5,57)years old.A total of 42 cases were included in the control group.The average duration of the disease was 730(300,1916)days.Among them,there were 24 males and 18 females,with an average age of 50(35.75,53.25)years old.There was no significant difference in age,gender,course of disease,dialysis,history of hypertension,number of people with history of diabetes,number of people with history of coronary heart disease,and number of people with history of RAAS inhibitor use between the two groups(P>0.05).(2)Clinical data of the patient:Heart rate,systolic blood pressure,diastolic blood pressure,height,weight,hemoglobin,white blood cell count,platelet count,uric acid,total protein,albumin,fasting blood glucose,glycosylated hemoglobin,high-density lipoprotein,observation group and control group There was no statistically significant difference in low-density lipoprotein at the baseline level(P>0.05).Compared with the control group,the observation group had lower baseline creatinine and urea nitrogen levels,and higher levels of eGFR,B-type natriuretic peptide,total cholesterol,and triglycerides(P<0.05).(3)Changes of serum potassium before and after 2 hours of medication:The potassium reduction rate of 37 cases in the observation group was 0.7214±0.3761mmol/Land there was a statistically significant difference before and after treatment(P<0.001).In the control group,the potassium reduction rate of 42 cases was 0.878±0.478mmol/L,and the difference was statistically significant(P<0.001).However,there was no statistically significant difference between the two groups of blood potassium levels before and after medication and the extent of potassium reduction between the two groups(P>0.05).(4)Comparison of serum potassium levels of patients in different groups:In the observation group,the patients were divided into 3 groups according to their initial venous potassium levels,<5.5 mmol/L group,5.5～<6.0 mmol/L group,≥6.0 mmol/L group,and there was no statistical difference in serum potassium reduction between the 3 groups Learning significance(P=0.0734).In the control group,there was a statistically significant difference in serum potassium reduction between the 3 groups(P=0.002).In the observation group and the control group,the patients were divided into two groups according to whether they were dialysis or not.There was no statistically significant difference in the magnitude of potassium reduction between the two groups(P>0.05).(5)Changes in the level of other electrolyte elements:In the observation group,there was no significant difference in blood calcium,phosphorus,sodium,chloride,magnesium,and carbon dioxide levels before and after treatment(P>0.05).In the control group,there was a statistically significant difference in blood sodium levels before and after medication(P=0.0204).There was no statistically significant difference in blood calcium,phosphorus,chloride,magnesium,and carbon dioxide levels before and after medication(P>0.05).No adverse reactions were recorded in the two groups.(6)There was no statistically significant correlation between the magnitude of potassium reduction and history of dialysis,history of hypertension,history of coronary heart disease,history of diabetes,creatinine,urea nitrogen,uric acid and eGFR(P>0.05).The magnitude of potassium reduction was statistically correlated with the blood potassium level before potassium reduction(P=0.015)and the history of RAAS inhibitor use(P=0.03).(7)Some patients with hyperkalemia have maintained their blood potassium levels within the normal range after long-term use of sodium zirconium cyclosilicate powder outside the hospital.Three patients developed nausea.Conclusion1.Sodium zirconium cyclosilicate powder can effectively reduce serum potassium in patients with CKD hyperkalemia within 2 hours.2.Sodium zirconium cyclosilicate powder can maintain the normal blood potassium level of CKD patients for a long time. |
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