Nefroloji Polikliniği’nde Hiperpotasemi Saptanan Hastaların Klinik ve Laboratuvar Özellikleri

Amaç: Bu çalışmanın amacı, nefroloji polikliniğine başvuran hastalarda hiperpotasemi prevalansını saptamak, hiperpotasemi ile hastaların demografik özellikleri, kullanmakta oldukları ilaçlar ve ek hastalıklar arasındaki ilişkiyi incelemektir. Materyal ve Metot: Çalışmaya 1 Ocak 2016-30 Haziran 2016 tarihleri arasında Nefroloji Polikliniğine başvuran, serum örneklerinde potasyum değeri 5,1 mEq/L ve üzerinde olan ve renal replasman tedavisi almayan 388 hasta alındı. Hastaların cinsiyeti, yaşı, kan basıncı, ek hastalıkları, kullandıkları ilaçlar, biyokimyasal tetkikler, 24 saatlik idrarda total protein ve albumin düzeyleri, daha önceki atak sayıları ve uygulanan tedaviler incelendi. İstatistiksel analiz bilgisayarda SPSS ver.17.0 programı kullanılarak gerçekleştirildi. Bulgular: Çalışmaya alınan hastaların 212'si (%54,6) kadın, 176'sı (%45,4) erkekti. Hastaların yaş ortalaması 65,76±12,9 yıl olarak bulundu. Hiperpotasemi prevalansı %15,9 ve ortalama potasyum düzeyi 5,49±0,36 mEq/L tespit edildi. Hastaların %57'sinde hafif, %31,5'inde orta, %11,5'inde ciddi hiperpotasemi saptandı. Çalışmaya alınan 293 hastada (%75,5) anjiotensin dönüştürücü enzim inhibitörü (ACEİ) veya anjiotensin reseptör blokeri (ARB) kullanımı; 36 hastada (%9,3) ACEİ veya ARB ile birlikte spironolakton kullanımı; 147 hastada (%37,9) beta bloker kullanımı mevcuttu. Hastaların %85,5'inde kronik böbrek hastalığı (KBH) ve %56,2'sinde diyabetes mellitus olduğu saptandı. Hiperpotasemisi olan 13 (%3,4) hastaya acil tedavi uygulandı. Acil hemodiyaliz ihtiyacı olmadı. Analizlerde; serum potasyum düzeyinin ACEİ veya ARB ile birlikte spironolakton kullanan hastalarda, kullanmayanlara göre anlamlı olarak daha yüksek olduğu tespit edildi (p=0,001). Sonuç: Özellikle KBH varlığında renin anjiotensin aldosteron sistem inhibitörü ilaçların birlikte kullanımının hiperpotasemi gelişme riskini arttırdığı göz önüne alınıp hastaların bu açıdan takip edilmesi gerekmektedir.

Anahtar Kelimeler:

Hiperpotasemi, etiyoloji, kronik böbrek hastalığı

Clinical and Laboratory Features of Patients with Hyperpotasemia in Nephrology Outpatient Clinic

Aim: The objective of this study is to determine the prevalence of hyperkalemia in patients admitted to nephrology outpatient clinic, to investigate the relationship between hyperkalemia and demographic characteristics of patients, comorbidities and drugs. Material and Method: 388 patients admitted to Nephrology Outpatient Clinic between 1 January 2016 and 30 June 2016 and whose serum potassium value is ≥5.1 mEq/L and without renal replacement therapy were included in the study. Patient’s gender, age, blood pressure, comorbidities, drugs, biochemical examination, total protein and albumin in 24 hour urine collection, the number of previous attacks and treatment approaches were examined. Statistical analysis was performed with using SPSS ver. 17.0 program. Results: Patients included in this study were consist of 212 (54.6%) female and 176 (45.4%) male. The average age of the patients was 65.76±12.09 years. The prevalence of hyperkalemia was 15.9% and the average potassium level was 5.49±0.36 mEq/L. When hyperkalemic patients were categorized into groups, 57 % had mild, 31.5% had moderate and 11.5% had severe hyperkalemia. In our study, there was 293 patients (75.5%) using angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), 36 patients (9.3%) using spironolactone with ACEI or ARB, and 147 patients (37.9%) using beta blockers. It was shown that 85.5 % of the patients had chronic kidney disease (CKD) and 56.2% had diabetes mellitus. Thirteen patients (3.4%) with hyperkalemia underwent emergency treatment. There was no patient needed urgent hemodialysis. Significant differences were found between those who did or did not use spironolactone combination therapy with ACEI or ARB (p=0.001). Conclusion: Particularly in CKD patients, the use of a combination of renin angiotensin aldosterone system inhibitors increases the risk of developing hyperkalemia, and patients should be monitored in this respect.

Keywords:

Hyperkalemia, etiology, chronic kidney disease,

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