Hypokalemia in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

腹膜透析病人的低血鉀

王家良(Chia-Liang Wang) ； 楊得政(Te-Cheng Yang) ； 徐國雄(Kuo-Hsiung Shu) ； 鄭志雄(Chi-Hung Cheng) ； 吳明儒(Ming-Ju Wu) ； 陳呈旭(Cheng-Hsu Chen)

《Acta Nephrologica》 22卷1期 (2008/03) Pp. 16-19

摘要

背景：本研究是為探討腹膜透析病人發生低血鉀的可能原因。
方法：20位腹膜透析病人納入本研究。第一組是低血鉀病人（10位），第2組是正常血鉀病人。有糖尿病及使用B-阻斷劑或利尿劑的病人被排除。每日鉀流失，包括透析液鉀流失及尿液鉀流失，及空腹胰島素血濃度被檢測。
結果：在兩組，血鈉、鈣、白蛋白濃度是相近的。每日鉀流失及透析液鉀流失在第裡組較多。空腹胰島素血液濃度在第1組較高。
結論：本研究顯示腹膜透析的低血鉀並非是透析液流失所造成。而是和高空腹胰島素血液濃度有關。我們假設在腹膜透析的高糖攝取導致高胰島素血液濃度導致低血鉀。

關鍵字

腹膜透析 ； 低血鉀 ； 高胰島素血液濃度

並列摘要

Background: The present study was undertaken to assess the possible causes of hypokalemia, which occurs in 10-36% of continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: Twenty CAPD patients enrolled in the study were assigned to two groups according to their serum potassium levels. Group Ⅰ comprised ten patients with hypokalemia (serum potassium level＜3.5 meqll for three consecutive months); Group Ⅱ comprised ten patients with normokalemia. Patients with diabetes, or those receiving medications such as beta-blockers, angiotensin-converting-enzyme inhibitors, or diuretics were excluded. Patients in both groups were monitored for daily total potassium loss (TKL) including dialysate (DKL) and urinary potassium loss (UKL), and fasting serum insulin concentration.
Results: The underlying biochemical values including sodium, calcium, and albumin were similar in both groups. DKL and TKL were significantly increased in Group Ⅱ (DKL, 30.10±3.31 versus 37.35±9.78 mEqld, p=0.048; TKL, 32.54±3.39 versus 44.21±8.29 mEqld in Groups Ⅰ and Ⅱ respectively) (p=0.001). The average fasting serum insulin level was higher in Group Ⅰ than in Group Ⅱ (35.06±4.99 versus 27.17±5.37 mUN, p=0.003).
Conclusion: The findings suggested hypokalemia in CAPD patients did not result from excessive potassium loss in the dialysate, but was associated with fasting hyperinsulinemia. We hypothesize glucose loading during CAPD stimulated hyperinsulinemia resulted in hypokalemia by shifting potassium to the intracellular space.

並列關鍵字

hypokalemia ； peritoneal dialysis ； hyperinsulinemia