Relationship between Rasi and Hyperkalemia in Maintenance Hemodialys Patients

Background: Although their security in terms of serum potassium is controversial, renin-angiotensin-aldosterone system inhibitors (RASi) have greater beneficial effects on protecting relative function of the heart and kidneys than other groups of antihypertensive drugs in hemodialysis ( HD ) patients. Therefore, the aim of our study was to investigate whether medications- angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) - would affect serum potassium in chronic HD patients. Methods We conducted a retrospective study of 166 adults HD patients to determine which factors including RASi were connected with hyperkalemia, defined as a pre-dialysis serum potassium concentration more than 5.0 mmol/L（K + ＞ 5.0mmol/L）. And it was divided into two groups, normal group and hyperkalemia one, by the serum potassium value. Finally, we compared the differences in baseline data between two groups and explore causes leading serum potassium unstable in long-term hemodialysis patients. Results The median serum potassium value of all participants was 4.78 (4.28, 5.41) mmol/L, and 64 (38.6%) of them had experienced hyperkalemia. 82 (49.4%) patients were prescribed with RASi. Three variables - serum phosphorus (P＜0.01), albumin (P＜0.05), and using RASi (P＜0.01) – were more frequent in hyperkalemia group. Multivariate logistic regression analysis showed that RASi (OR: 3.63, 95% CI: 1.78-7.40, P＜0.01), serum phosphorus (OR: 2.07, 95% CI: 1.29-3.34, P＜0.01),UCR (OR: 1.20, 95% CI: 1.05-1.37, P＜0.01), and age (OR: 0.98, 95% CI: 0.95-0.99, P＜0.05) were associated with hyperkalemia. Conclusion In this study, hyperkalemia is observed in 38.6% of HD patients. The use of RASi is associated with hyperkalemia in patients on prevalent HD. Also, patients with higher serum potassium or UCR and young age are likely to develop hyperkalemia during interdialysis interval.