Yinna Wang, Kenneth R Phelps, Darren E Gemoets, Elvira O Gosmanova
{"title":"慢性肾病患者血清钾浓度的决定因素。","authors":"Yinna Wang, Kenneth R Phelps, Darren E Gemoets, Elvira O Gosmanova","doi":"10.5414/CN111490","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>If C<sub>cr</sub> is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (K<sub>s</sub>) is the sum of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (K<sub>s</sub> = E<sub>K</sub>/C<sub>cr</sub> + TR<sub>K</sub>/C<sub>cr</sub>). We investigated changes in E<sub>K</sub>/C<sub>cr</sub>, TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> through the stages of chronic kidney disease (CKD).</p><p><strong>Materials and methods: </strong>We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (K<sub>s</sub>, K<sub>u</sub>, cr<sub>s</sub>, and cr<sub>u</sub>) were used to calculate 1,007 individual values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> as K<sub>u</sub>×cr<sub>s</sub>/cr<sub>u</sub> and K<sub>s</sub> - E<sub>K</sub>/C<sub>cr</sub>, respectively. Mean values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (K<sub>s</sub> > 5.1 mmol/L), normokalemia (K<sub>s</sub> 3.8 - 5.1 mmol/L), and hypokalemia (K<sub>s</sub> < 3.8 mmol/L).</p><p><strong>Results: </strong>In comparison to values in CKD stages G1 - 2, E<sub>K</sub>/C<sub>cr</sub> rose and TR<sub>K</sub>/C<sub>cr</sub> fell in each higher stage. Decrements in TR<sub>K</sub>/C<sub>cr</sub> equaled increments in E<sub>K</sub>/C<sub>cr</sub> in G3a and G3b, and K<sub>s</sub> remained stable. In G4 - 5, the ascent of E<sub>K</sub>/C<sub>cr</sub> exceeded the decline in TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> rose accordingly. Within each CKD stage, E<sub>K</sub>/C<sub>cr</sub> was remarkably similar in the three kalemic subsets; consequently, differences in TR<sub>K</sub>/C<sub>cr</sub> were the sole source of differences in K<sub>s</sub>.</p><p><strong>Conclusion: </strong>E<sub>K</sub>/C<sub>cr</sub> rises and TR<sub>K</sub>/C<sub>cr</sub> falls through the stages of CKD. K<sub>s</sub> remains stable in stages G3a - 3b in association with equal and opposite changes in E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>. In stages G4 - 5, K<sub>s</sub> increases progressively because E<sub>K</sub>/C<sub>cr</sub> rises more than TR<sub>K</sub>/C<sub>cr</sub> falls. Within each CKD stage, differences in TR<sub>K</sub>/C<sub>cr</sub> account entirely for differences in K<sub>s</sub> among hyper-, normo-, and hypokalemic subsets. Causes of variability of TR<sub>K</sub>/C<sub>cr</sub> require additional investigation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Determinants of the serum potassium concentration in chronic kidney disease.\",\"authors\":\"Yinna Wang, Kenneth R Phelps, Darren E Gemoets, Elvira O Gosmanova\",\"doi\":\"10.5414/CN111490\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>If C<sub>cr</sub> is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (K<sub>s</sub>) is the sum of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (K<sub>s</sub> = E<sub>K</sub>/C<sub>cr</sub> + TR<sub>K</sub>/C<sub>cr</sub>). We investigated changes in E<sub>K</sub>/C<sub>cr</sub>, TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> through the stages of chronic kidney disease (CKD).</p><p><strong>Materials and methods: </strong>We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (K<sub>s</sub>, K<sub>u</sub>, cr<sub>s</sub>, and cr<sub>u</sub>) were used to calculate 1,007 individual values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> as K<sub>u</sub>×cr<sub>s</sub>/cr<sub>u</sub> and K<sub>s</sub> - E<sub>K</sub>/C<sub>cr</sub>, respectively. Mean values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (K<sub>s</sub> > 5.1 mmol/L), normokalemia (K<sub>s</sub> 3.8 - 5.1 mmol/L), and hypokalemia (K<sub>s</sub> < 3.8 mmol/L).</p><p><strong>Results: </strong>In comparison to values in CKD stages G1 - 2, E<sub>K</sub>/C<sub>cr</sub> rose and TR<sub>K</sub>/C<sub>cr</sub> fell in each higher stage. Decrements in TR<sub>K</sub>/C<sub>cr</sub> equaled increments in E<sub>K</sub>/C<sub>cr</sub> in G3a and G3b, and K<sub>s</sub> remained stable. In G4 - 5, the ascent of E<sub>K</sub>/C<sub>cr</sub> exceeded the decline in TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> rose accordingly. Within each CKD stage, E<sub>K</sub>/C<sub>cr</sub> was remarkably similar in the three kalemic subsets; consequently, differences in TR<sub>K</sub>/C<sub>cr</sub> were the sole source of differences in K<sub>s</sub>.</p><p><strong>Conclusion: </strong>E<sub>K</sub>/C<sub>cr</sub> rises and TR<sub>K</sub>/C<sub>cr</sub> falls through the stages of CKD. K<sub>s</sub> remains stable in stages G3a - 3b in association with equal and opposite changes in E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>. In stages G4 - 5, K<sub>s</sub> increases progressively because E<sub>K</sub>/C<sub>cr</sub> rises more than TR<sub>K</sub>/C<sub>cr</sub> falls. Within each CKD stage, differences in TR<sub>K</sub>/C<sub>cr</sub> account entirely for differences in K<sub>s</sub> among hyper-, normo-, and hypokalemic subsets. Causes of variability of TR<sub>K</sub>/C<sub>cr</sub> require additional investigation.</p>\",\"PeriodicalId\":10396,\"journal\":{\"name\":\"Clinical nephrology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-10-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5414/CN111490\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5414/CN111490","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Determinants of the serum potassium concentration in chronic kidney disease.
Background: If Ccr is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (Ks) is the sum of EK/Ccr and TRK/Ccr, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (Ks = EK/Ccr + TRK/Ccr). We investigated changes in EK/Ccr, TRK/Ccr, and Ks through the stages of chronic kidney disease (CKD).
Materials and methods: We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (Ks, Ku, crs, and cru) were used to calculate 1,007 individual values of EK/Ccr and TRK/Ccr as Ku×crs/cru and Ks - EK/Ccr, respectively. Mean values of EK/Ccr and TRK/Ccr were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (Ks > 5.1 mmol/L), normokalemia (Ks 3.8 - 5.1 mmol/L), and hypokalemia (Ks < 3.8 mmol/L).
Results: In comparison to values in CKD stages G1 - 2, EK/Ccr rose and TRK/Ccr fell in each higher stage. Decrements in TRK/Ccr equaled increments in EK/Ccr in G3a and G3b, and Ks remained stable. In G4 - 5, the ascent of EK/Ccr exceeded the decline in TRK/Ccr, and Ks rose accordingly. Within each CKD stage, EK/Ccr was remarkably similar in the three kalemic subsets; consequently, differences in TRK/Ccr were the sole source of differences in Ks.
Conclusion: EK/Ccr rises and TRK/Ccr falls through the stages of CKD. Ks remains stable in stages G3a - 3b in association with equal and opposite changes in EK/Ccr and TRK/Ccr. In stages G4 - 5, Ks increases progressively because EK/Ccr rises more than TRK/Ccr falls. Within each CKD stage, differences in TRK/Ccr account entirely for differences in Ks among hyper-, normo-, and hypokalemic subsets. Causes of variability of TRK/Ccr require additional investigation.
期刊介绍：
Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.
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