Sistemik Lupus Eritematozuslu Hastalarda Hiperkalemi Nedenlerinin Değerlendirilmesi: Retrospektif, tek merkez deneyimi

Afida Mammadova; Döndü Üsküdar Cansu; Cengiz Korkmaz

doi:10.20515/otd.1162497

Research Article

Sistemik Lupus Eritematozuslu Hastalarda Hiperkalemi Nedenlerinin Değerlendirilmesi: Retrospektif, tek merkez deneyimi

Year 2023, Volume: 45 Issue: 1, 13 - 21, 23.01.2023

Afida Mammadova Döndü Üsküdar Cansu Cengiz Korkmaz

https://doi.org/10.20515/otd.1162497

Abstract

Hiperkalemi, yaşamı tehdit edici sonuçlara yol açabilen önemli bir elektrolit bozukluğudur. Hiperkalemi sıklığı ve nedenleri çalışılan populasyona göre değişmektedir. Başlıca risk faktörleri renal yetmezlik, diyabetes mellitus (DM) ve anjiyotensin dönüştürücü enzim (ACE) inhibitörü gibi ilaçların kullanımıdır. Sistemik lupus eritematozus (SLE) seyrinde hiperkalemi nedenleri şimdiye kadar araştırılmamıştır. Amacımız, SLE’li hastalarda hiperkalemi nedenlerini ayrıntılı olarak ortaya koymak ve hiperkalemik renal tubuler asidoz (RTA) tip 4 sıklığını belirlemekti. Ocak 2010-Şubat 2020 yılları arasında Romatoloji bölümünde SLE tanısı ile takip edilen ve potasyum düzeyi ≥5.5 mEq/L (hiperkalemi) olan hastalar belirlendi. Hiperkalemi saptanan hastaların klinik ve laboratuvar bulguları dosyalarından ve dijital kayıt sisteminden retrospektif olarak tarandı. SLE dışı tanısı olanlar, hiperkalemisi olmayan hastalar çalışma dışı bırakıldı. Hiperkalemi nedenleri renal hasar/yetmezlik [akut böbrek hasarı, kronik böbrek hastalığı (KBH)], ilaçlar, hormonal nedenler (Addison hastalığı, tip 4 RTA), psödohemoliz ve diğer olarak sınıflandırıldı. Hiperkalemi saptanan 35 SLE’li hastanın yaş ortalaması 40.1±16.9 yıl iken hastaların %85.7’si kadındı. Hastaların %57.1’inde (n=20) lupus nefriti vardı. En sık görülen renal tutulum tipi %68.7 (11/16) ile sınıf 4 lupus nefriti idi. Hiperkalemi saptandığı sıradaki SLE hastalık süresi ortalaması 5.2±5.52 yıl, hastalık aktivasyon indeksi-SLEDAI ortalama 19.8±13.4 idi. Potasyum ortalaması 6.6 ±1.08 mEq/L idi. En sık hiperkalemi nedeni %45.7 (n=16) ile renal hasar/hastalık iken bunu %25.7 ile ilaç kullanımı izlemişti. 2 (%5) hastada hiperkalemi RTA tip 4’e bağlanmıştı. Gruplar hiperkalemi nedenlerine göre klinik ve laboratuvar parametreleri açısından karşılaştırıldığında renal hasar/hastalığı grubunda kreatin yüksekliği daha fazla idi (p≤0.001). SLE seyrinde hiperkalemi, genel toplumda görüldüğü gibi en çok renal hasara/hastalığa bağlı olarak ortaya çıkmaktadır. Bunun yanında RTA tip 4 de hiperkaleminin önemli bir nedenidir. Hiperkalemisi olan SLE’li hastalar sık görülen hiperkalemi nedenleri dışlandıktan sonra veya dirençli hiperkalemi varlığında hiperkalemik RTA tip 4 açısından da araştırılmalıdır.

Keywords

Sistemik Lupus Eritematozus, Hiperkalemi, Hiperpotasemi, Renal Tubuler Asidoz

References

1. Kaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R, Ruiz-Irastorza G, Hughes G. Systemic lupus erythematosus. Nat Rev Dis Primers. 2016 Jun 16;2:16039.
2. Anders HJ, Saxena R, Zhao MH, Parodis I, Salmon JE, Mohan C. Lupus nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7.
3. Palmer BF, Carrero JJ, Clegg DJ, Colbert GB, Emmett M, Fishbane S, Hain DJ, Lerma E, Onuigbo M, Rastogi A, Roger SD, Spinowitz BS, Weir MR. Clinical Management of Hyperkalemia. Mayo Clin Proc. 2021 Mar;96(3):744-762.
4. Aygencel G. Potasyum Metabolizması Bozuklukları. Yoğun Bakım Dergisi 2018;12(1):31-42.
5. Hunter RW, Bailey MA. Hyperkalemia: pathophysiology, risk factors and consequences. Nephrol Dial Transplant. 2019 Dec 1;34(Suppl 3):iii2-iii11.
6. Üsküdar Cansu D, Cansu GB, Güvenir S, Korkmaz C. Hyperkalemia in type 4 renal tubular acidosis associated with systemic lupus erythematosus. Rheumatol Int. 2020 Nov;40(11):1895-1901.
7. Lee FO, Quismorio FP Jr, Troum OM, Anderson PW, Do YS, Hsueh WA. Mechanisms of hyperkalemia in systemic lupus erythematosus. Arch Intern Med. 1988 Feb;148(2):397-401.
8. Humphrey T, Davids MR, Chothia MY, Pecoits-Filho R, Pollock C, James G. How common is hyperkalaemia? A systematic review and meta-analysis of the prevalence and incidence of hyperkalaemia reported in observational studies. Clin Kidney J. 2021 Dec 2;15(4):727-737.
9. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725. 10. Pollack K, Manning KR, Balassone J, Bui C, Taylor DM, Taylor SE. Hyperkalaemia in the emergency department: Epidemiology, management and monitoring of treatment outcomes. Emerg Med Australas. 2022 Apr 11. doi: 10.1111/1742-6723.13971. Online ahead of print.
11. Mclean A, Nath M, Sawhney S. Population Epidemiology of Hyperkalemia: Cardiac and Kidney Long-term Health Outcomes. Am J Kidney Dis. 2022 Apr;79(4):527-538.e1. 12. Li SL, Liou LB, Fang JT, Tsai WP. Symptomatic renal tubular acidosis (RTA) in patients with systemic lupus erythematosus: an analysis of six cases with new association of type 4 RTA. Rheumatology (Oxford). 2005 Sep;44(9):1176-80.
13. Kang MJ, Kwak CH, Jin KB, Whang EA, Han SY, Park SB, Kim HC. Clinical observation on hyperkalemic distal renal tubular acidosis. Korean J Nephrol. 2004;23:263–269.

Evaluation of Causes of Hyperkalemia in Systemic Lupus Erythematosus Patients: Retrospective Single-Center Experience

Year 2023, Volume: 45 Issue: 1, 13 - 21, 23.01.2023

Afida Mammadova Döndü Üsküdar Cansu Cengiz Korkmaz

https://doi.org/10.20515/otd.1162497

Abstract

Hyperkalemia is a major electrolyte disturbance with potentially life-threatening consequences. Varying prevalence and causes of hyperkalemia have been reported for study populations. Primary risk factors include renal insufficiency, diabetes mellitus (DM) and use of certain medication such as angiotensin converting enzyme (ACE) inhibitors. So far, causes of hyperkalemia in systemic lupus erythematosus (SLE) have not been investigated. Our aim here is to elaborate the causes underlying hyperkalemia and to determine the prevalence of hyperkalemic Type 4 renal tubular acidosis (RTA) in SLE patients. Among the patients followed up at the Department of Rheumatology due to SLE between January 2010 and February 2020, those with a potassium level of ≥5.5 mEq/L (hyperkalemia) were identified. For hyperkalemia patients, patient charts and digital record system were retrospectively searched for clinical and laboratory findings. Those with a non-SLE diagnosis and without hyperkalemia were excluded. Causes of hyperkalemia were classified as renal failure/insufficiency [acute kidney injury, chronic kidney disease (CKD)], medication, hormonal reasons (Addison’s disease, Type 4 RTA), pseudo-hemolysis, and others. Hyperkalemia was identified in 35 SLE patients, who were 40.1±16.9 years old, on average, and 85.7% of them were female. In 57.1% of the patients (n=20) lupus nephritis was identified. The most common type of renal involvement was Class IV lupus nephritis, at a rate of 68.7% (11/16). At the time of hyperkalemia diagnosis, mean duration of SLE disease was 5.2±5.52 years and mean SLE disease activation index (SLEDAI) was 19.8±13.4. Mean potassium level was 6.6 ±1.08 mEq/L. Metabolic acidosis was detected in 40% of the patients. The most common cause of hyperkalemia was renal failure/disease in 45.7% (n=16), followed by use of medication in 25.7%. In two (5%) patients hyperkalemia was attributed to Type 4 RTA. When patient subsets were compared by their causes of hyperkalemia for clinical and laboratory parameters, subset of renal failure/disease has a higher level of creatinine (p≤0.001), but there was no difference in other parameters. In line with its occurrence in general population, hyperkalemia in SLE most often occurs due to renal failure/disease. In addition, Type 4 RTA is an important reason for hyperkalemia. SLE patients presenting with hyperkalemia should also be queried for hyperkalemic Type 4 RTA, once the common causes for hyperkalemia are ruled out or in the event of persistent hyperkalemia.

Keywords

Systemic Lupus Erythematosus; Hyperkalemia; Hyperpotassemia; Renal Tubular Acidosis

References

1. Kaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R, Ruiz-Irastorza G, Hughes G. Systemic lupus erythematosus. Nat Rev Dis Primers. 2016 Jun 16;2:16039.
2. Anders HJ, Saxena R, Zhao MH, Parodis I, Salmon JE, Mohan C. Lupus nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7.
3. Palmer BF, Carrero JJ, Clegg DJ, Colbert GB, Emmett M, Fishbane S, Hain DJ, Lerma E, Onuigbo M, Rastogi A, Roger SD, Spinowitz BS, Weir MR. Clinical Management of Hyperkalemia. Mayo Clin Proc. 2021 Mar;96(3):744-762.
4. Aygencel G. Potasyum Metabolizması Bozuklukları. Yoğun Bakım Dergisi 2018;12(1):31-42.
5. Hunter RW, Bailey MA. Hyperkalemia: pathophysiology, risk factors and consequences. Nephrol Dial Transplant. 2019 Dec 1;34(Suppl 3):iii2-iii11.
6. Üsküdar Cansu D, Cansu GB, Güvenir S, Korkmaz C. Hyperkalemia in type 4 renal tubular acidosis associated with systemic lupus erythematosus. Rheumatol Int. 2020 Nov;40(11):1895-1901.
7. Lee FO, Quismorio FP Jr, Troum OM, Anderson PW, Do YS, Hsueh WA. Mechanisms of hyperkalemia in systemic lupus erythematosus. Arch Intern Med. 1988 Feb;148(2):397-401.
8. Humphrey T, Davids MR, Chothia MY, Pecoits-Filho R, Pollock C, James G. How common is hyperkalaemia? A systematic review and meta-analysis of the prevalence and incidence of hyperkalaemia reported in observational studies. Clin Kidney J. 2021 Dec 2;15(4):727-737.
9. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725. 10. Pollack K, Manning KR, Balassone J, Bui C, Taylor DM, Taylor SE. Hyperkalaemia in the emergency department: Epidemiology, management and monitoring of treatment outcomes. Emerg Med Australas. 2022 Apr 11. doi: 10.1111/1742-6723.13971. Online ahead of print.
11. Mclean A, Nath M, Sawhney S. Population Epidemiology of Hyperkalemia: Cardiac and Kidney Long-term Health Outcomes. Am J Kidney Dis. 2022 Apr;79(4):527-538.e1. 12. Li SL, Liou LB, Fang JT, Tsai WP. Symptomatic renal tubular acidosis (RTA) in patients with systemic lupus erythematosus: an analysis of six cases with new association of type 4 RTA. Rheumatology (Oxford). 2005 Sep;44(9):1176-80.
13. Kang MJ, Kwak CH, Jin KB, Whang EA, Han SY, Park SB, Kim HC. Clinical observation on hyperkalemic distal renal tubular acidosis. Korean J Nephrol. 2004;23:263–269.

There are 11 citations in total.

Details

Primary Language	Turkish
Subjects	Health Care Administration
Journal Section	ORİJİNAL MAKALE
Authors	Afida Mammadova 0000-0003-0164-4601 Döndü Üsküdar Cansu 0000-0001-6543-3905 Cengiz Korkmaz 0000-0003-2679-0699
Publication Date	January 23, 2023
Published in Issue	Year 2023 Volume: 45 Issue: 1

Cite

Vancouver	Mammadova A, Üsküdar Cansu D, Korkmaz C. Sistemik Lupus Eritematozuslu Hastalarda Hiperkalemi Nedenlerinin Değerlendirilmesi: Retrospektif, tek merkez deneyimi. Osmangazi Tıp Dergisi. 2023;45(1):13-21.