基于血钾变化模式强化血液透析患者高钾血症管理

Optimizing Hyperkalemia Management in Hemodialysis Patients Based on Serum Potassium Fluctuation Patterns

摘要: 目的：探讨基于血钾变化模式的干预策略对血液透析患者高钾血症管理的临床效果。方法：前瞻性、单中心、临床观察性研究，选取2023年1月至2025年6月在本院接受血液透析治疗的并发慢性高钾血症患者108例，随机分为实验组(54例)与对照组(54例)。实验组依据血钾变化模式制定透析间期使用环硅酸锆钠联合饮食指导。对照组采用饮食指导。观察3个月血钾变化情况。结果实验组血钾水平从干预前5.70 ± 0.46 mmol/l下降至干预3月后的4.80 ± 0.63 mmol/l，与对照组干预前5.65 ± 0.43 mmol/l至干预3月后5.36 ± 0.65 mmol/l的每个时间点对比，实验组血钾达标率明显优于对照组，P < 0.001。未发现与治疗有关的不良反应。结论：基于血钾变化模式的个体化干预能有效提升血液透析患者高钾血症的管理效果。

Abstract: Objective: To explore the clinical effect of an intervention strategy based on the potassium change pattern on the management of hyperkalemia in hemodialysis patients. Methods: A prospective, single-center, observational clinical study was conducted. A total of 108 patients with concurrent chronic hyperkalemia who received hemodialysis treatment in our hospital from January 2023 to June 2025 were randomly divided into an experimental group (54 cases) and a control group (54 cases). The experimental group was given sodium zirconium cyclosilicate during the interdialytic period and dietary guidance based on the potassium change pattern. The control group received only dietary guidance. The changes in blood potassium levels were observed over a period of 3 months. Results: The blood potassium level in the experimental group decreased from 5.70 ± 0.46 mmol/L before the intervention to 4.80 ± 0.63 mmol/L after 3 months of intervention. Compared with the control group, whose blood potassium level decreased from 5.65 ± 0.43 mmol/L before the intervention to 5.36 ± 0.65 mmol/L after 3 months of intervention, the rate of reaching the standard blood potassium level in the experimental group was significantly better than that in the control group at each time point, P < 0.001. No treatment-related adverse events were detected during the study period. Conclusion: Individualized intervention based on the potassium change pattern can effectively improve the management of hyperkalemia in hemodialysis patients.