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만성 신부전 환자에서 혈액투석 중 칼륨 균형의 내적 장애에 관한 연구
이경원,김태영,김기찬,김호중,한상웅,유영조,오석중,박일규 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.6
Hernodialysis(HD) patients are continuously exposed to hyperkalemia, the degree of which depends on the amount of dialysate potassium(K) removal and intracompartmental K shifts besides poor dietary K compliance. Chronically hyperkalemic outpatients(n=20) on chronic hernodialysis by routine monthly serum potassium(SK) concentration measurements(SK≥5.1mEq/L, more than 4 times in 6 months) was looked for the derangements of short-term interval K handling by observing the pattern of change in plasma K(PK) thru HD. In all 20 patients, as expected, the predialysis PK(PKo, 5.3±0.16mEq/L) were significantly correlated with the end-dialysis PK(PKe, 3.8±0.09mEq/l.)(r=0.65, p$lt;0.01) and the magnitude of the fall in PK(PKo-PKe, 1.6±0.55mEq/L)(r=0.85, p$lt;0.0001). Also, PKo were negatively correlated with anion gap(r=-0.50, p$lt;0.05) and plasma Na level(r=-0.69, p$lt;0.01). PK at 2 hours after HD(PKr, 4.6±0.13mEq/L) revealed a marked postdialytic K rebound. PKr correlated with PKe, whereas no significant correlation between the magnitude of the rise in PKe(PKr-PKe) and PKe was found. Of 20 hyperkalemic patients, PK of 9 patients(group I), surprisingly, showed normokalemia(4.7±0.09mF) and that of 11(group II) showed true hyperkalernia(5.8$gt;0.19 mEq/L). Between 2 groups, significant differences were found in plasma Na level(140±0.8 vs. 136±0.7mEq/L, p$lt;0.01) and the percentage of(PKr-PKe) divided by PKe(141.8 vs. 27±2.5Yo, p$lt;0.01), but no difference in anion gap, pH, albumin, creatinine, and(PKo-PKe) divided by PKO, respectively. Based on this data, we conclude that hyperkalemic hemodialysis patients should be confirmed by plasma K determination to exclude factitious hyperkalemia, and they may have the derangements of internal K balance due to transcompartmental K shifts following HD, which would be partly related to that of Na balance.