| Background and ObjectiveHyperkalemia is one of the most common serious complications in chronic kidney disease patients undergoing hemodialysis(HD).Even with adequate HD,patients still have a higher risk of recurring hyperkalemia.Hyperkalemia may cause life-threatening cardiac and neuromuscular alterations,and it is associated with high mortality rates.Emergency treatment approaches should be started as soon as possible after diagnosis of clinically relevant hyperkalemia in order to lower serum potassium to safe levels.A variety of drug treatment options are considered for the acute management of hyperkalemia,including:①intravenous insulin plus glucose,etc.;②cation-exchanging resin,such as sodium polystyrene sulfonate;③sodium zirconium cyclosilicate;④two-or three-modality combinations.There is no controlled study on the efficacy and safety of various drugs for reducing potassium in the correction phase of HD patients with acute hyperkalemia.This real world study evaluates the effectiveness of the different potassium-lowering regimens in the correction phase of hyperkalemia with HD patients.Materials and methodsThis real world study was conducted between June 10th 2020 to Feb 3rd 2021 among patients with chronic kidney disease and undergoing hemodialysis who were admitted to the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University.A total of 139 patients were finally included and given different potassium-lowering regimens.These patients were divided into four groups based on their potassium-lowering regimens respectively:the insulin and glucose(IG)intravenous administration group(IG,46 patients),the sodium polystyrene sulfonate group(SPS,33 patients),the sodium zirconium cyclosilicate group(SZC,38 patients),the IG intravenous administration combined with sodium zirconium cyclosilicate group(IG+SZC,22 patients).The changes of serum potassium,sodium,calcium and magnesium level,the potassium-level control rate and side effects after treatment were compared among the 4 groups.Results1.There were totally 139 patients included in our study,including 81 males and 58 females.The average age was(53.63±14.62)years and 129 patients had vascular access complications,47 patients had diabetes mellitus,65 patients had heart faiure There were no statistically significant differences in age,gender,number of oliguria,dialysis frequency,comorbidities,and combined medications among 4 groups(all P>0.05),but the IG group and SPS group had statistically significant differences in the time to last dialysis(P=0.038).2.Before potassium-lowering treatment,the differences in the baseline serum potassium levels of each group were statistically significant(H=27.32,P<0.01).The serum potassium levels of the IG+SZC group were significantly higher than the other three groups.Among the other three groups,the SZC group had the highest serum potassium level,but the difference was not statistically significant compared with the other two groups(H=2.90,P=0.235).In the IG+SZC group,the proportion of serum potassium≥6.5 mmol/L was 63.6%,and the proportion of severe hyperkalemia was 85.7%,which was significantly higher than the other three groups.3.After potassium-lowering treatment,the blood potassium levels of each group were statistically different(H=10.28,P=0.016).In the pairwise comparison,the blood potassium level of the IG group was significantly lower than the SPS group(P=0.017).Although the serum potassium level after treatment in the SZC group was lower than that in the SPS group,the difference was not statistically significant(P>0.05).4.After potassium-lowering treatment,the blood potassium levels of each group decreased significantly(P<0.01).The serum potassium was decreased by 0.71±0.32 mmol/L(11.89±5.19%)in IG group,0.43±0.38 mmol/L(7.12±6.32%)in SPS group,0.64±0.36 mmol/L(10.58±6.07%)in SZC group,1.43±0.38 mmol/L(21.51±5.74%)in IG+SZC group after the 2-hour treatment.The serum potassium level in IG+SZC group decreased more than that in the other three groups(P<0.01),while the serum potassium level in SPS group decreased less than that in the other three groups(P<0.05).There was no significant difference on the decrease of the serum potassium level between IG group and the SZC group(P=0.374).5.There was no statistically significant difference in the potassium-level control rates among 4 groups(P=0.176).The control rates of severe hyperkalemia between SZC group and SPS group was no significant difference(P=0.135).The rate of blood potassium drop less than 0.2 mmol/L in SPS group was significantly higher than SZC group.6.At the same time,the serum sodium showed no significant change before and after the treatment among four groups,serum calcium decreased significantly in IG group,SPS group and IG+SZC group and the serum magnesium decreased significantly in SPS group and IG+SZC group.7.During the potassium-lowering treatment,6 patients(13.0%)had hypoglycemia in the IG group,of which 4 patients(8.7%)were non-diabetic patients,2 patients(4.3%)were diabetic patients;4 patients(8.7%)had exacerbation symptoms of heart failure.In the SZC+IG group,2 patients(9.0%)had hypoglycemia,and 2 patients(9.0%)had exacerbation symptoms of heart failure.No obvious adverse reactions occurred in the SZC group and SPS group.ConclusionsIn the correction phase of hyperkalemia in HD patients,sodium zirconium cyclosilicate had similar effectiveness as intravenous administration and had more advantages in convenience and safety;intravenous administration has better effectiveness than SPS;combining SZC with intravenous administration,serum potassium level had a more rapidly decrease and higher control rate of serum potassium level. |
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