目的 观察中国慢性肾脏病高钾血症风险评估工具在维持性血液透析(maintenance hemodialysis，MHD)患者中的应用效果。 方法 纳入苏州高新区人民医院、南京医科大学附属苏州医院、上海交通大学医学院附属苏州九龙医院的MHD患者280例，对照组(n=142)予常规的高钾血症防治方法，试验组(n=138)基于高钾血症风险等级，采用查找、组织、澄清、了解、选择(find organize clarify understand select，FOCUS)-计划、执行、检查、操作(plan do check act，PDCA) 的持续质量改进模式进行分级干预，比较干预前后高钾血症相关指标。 结果 干预24周后，试验组的高钾血症患病比例 (x2=4.722，P=0.030)、血钾水平(t=2.850，P=0.005)低于对照组，透析充分性(Z=-5.360，P＜0.001)及生活质量(t=-4.004，P＜0.001)高于对照组。干预12 周、18 周、24周后，试验组的高钾血症患病比例 (x2=19.37，P＜0.001)、血钾水平(F=51.52，P＜0.001)低于干预前。干预24周后，31例(22.4%)极高危和高危患者转为中危级(Z=16.326，P=0.001)。 结论  基于高钾血症风险评估工具，采用FOCUS-PDCA模式对MHD患者进行分级管理，可降低血钾水平和高钾血症发生风险，提高透析充分性及生活质量，值得在临床中运用并进行推广。

Objective  The aim of this study was to observe the effect of the Chinese hyperkalemia risk assessment tool in maintenance hemodialysis (MHD) patients.   Methods   A total of 280 MHD patients from the three hospitals in the Suzhou New District were enrolled in this study. The control group (n=142) was given routine prevention and treatment methods for hyperkalemia. The experimental group (n=138) used Find, Organize, Clarify, Understand, Select, –Plan, Do, Check, Act (FOCUS-PDCA) model for graded intervention based on the risk level of hyperkalemia. The hyperkalemia related indexes were compared before and after the intervention.  Results  After 24 weeks of intervention, the prevalence of hyperkalemia (13.8% vs. 23.9%, c2=4.722, P=0.030) and blood potassium level (4.44±0.35 vs. 4.58±0.47mmol/l, t=2.850, P=0.005) were significantly lower in the experimental group than in the control group; the dialysis adequacy [1.32(1.22～1.54) vs. 1.24(1.20～1.30), Z=-5.360, P<0.001] and quality of life (63.79±14.59 vs. 56.30±16.29, t=-4.004, P<0.001) were significantly higher in the experimental group than in the control group. After 12, 18 and 24 weeks of intervention, the prevalence of hyperkalemia (36.2% vs. 31.2% vs. 27.5% vs. 13.8%, x2=19.37, P<0.001) and blood potassium level (5.02±0.43 vs. 4.81±0.42 vs. 4.68±0.39 vs. 4.44±0.35 mmol/L, F=51.52, P<0.001) in the experimental group decreased gradually along with the intervention duration. After 24 weeks of intervention, 31 extreme-risk or high-risk patients (22.4%) turned to moderate-risk level (Z=16.326, P=0.001).  Conclusion  Based on the hyperkalemia risk assessment tool, the hierarchical management of MHD patients through FOCUS-PDCA model can significantly reduce potassium level and risk of hyperkalemia, and improve dialysis adequacy and quality of life. This method is worthy of promotion for clinical application.