Frequency and predictors of hyperkalemia in the heart failure outpatient clinic

Yıl 2022, , 278 - 284, 31.12.2022

Gülsüm Meral Yılmaz Öztekin , Ahmet Genç , Anıl Şahin , Göksel Çağırcı , Şakir Arslan

https://doi.org/10.30565/medalanya.1172354

Öz

Aim: Hyperkalemia is a common and potentially life-threatening problem in heart failure (HF). In this study, we aimed to show the frequency of hyperkalemia and related factors in the HF outpatient clinic with real-life data.

Methods: 1 146 patients monitored in the HF outpatient clinic with left ventricular ejection fraction ≤ 40% and potassium level ≥ 3.5 mmol/L were included.

Results: The potassium value of the patients was median 4.6 mmol/L [IQR, 4.3-5]. It was evaluated in three groups as 3.5-5 mmol/L (normokalemia), 5.1-5.5 mmol/L (mild hyperkalemia) and ≥ 5.5 mmol/L (moderate to severe hyperkalemia), according to baseline potassium levels. Mild hyperkalemia was present in 14.5% and moderate to severe hyperkalemia was present in 7.1%. The potassium value was > 5 mmol/L in 21.6% of the patients. The estimated glomerular filtration rate (eGFR) (OR: 0.969, 95% CI: 0.961-0.976, p<0.001), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB) (OR: 1.697, 95% CI: 1.124-2.562, p=0.012), and mineralocorticoid receptor antagonists (MRA) (OR: 1.511, 95% CI: 1.066-2.142, p=0.02) were considered as independent factors for hyperkalemia.

Conclusion: eGFR level, ACE-I/ARB, and MRA were associated with hyperkalemia in chronic HF in real-life data.

Anahtar Kelimeler

Heart Failure, Hyperkalemia, Potassium, Renin-Angiotensin System.

Kalp yetmezliği polikliniğinde hiperkaleminin sıklığı ve öngördürücüleri

Öz

Amaç: Hiperkalemi, kalp yetmezliğinde (KY) yaygın ve potansiyel olarak yaşamı tehdit eden bir sorundur. Bu çalışmada KY polikliniğinde hiperkalemi sıklığı ve ilişkili faktörlerin gerçek yaşam verileriyle gösterilmesi amaçlanmıştır.

Yöntemler: KY polikliniğinde izlenen sol ventrikül ejeksiyon fraksiyonu ≤ %40 ve potasyum düzeyi ≥ 3.5 mmol/L olan 1146 hasta çalışmaya dahil edildi.

Bulgular: Hastaların medyan potasyum değeri 4.6 mmol/L [IQR, 4.3-5] idi. Başlangıç potasyum düzeylerine göre 3.5-5 mmol/L (normokalemi), 5.1-5.5 mmol/L (hafif hiperkalemi) ve ≥ 5.5 mmol/L (orta-ciddi hiperkalemi) olmak üzere üç grupta değerlendirildi. %14.5'inde hafif hiperkalemi ve %7.1'inde orta ila şiddetli hiperkalemi mevcuttu. Hastaların %21.6'sında potasyum değeri > 5 mmol/L idi. Tahmini glomerüler filtrasyon hızı (eGFR) (OR: 0.969, 95% CI: 0.961-0.976, p<0.001), anjiyotensin dönüştürücü enzim inhibitörü/anjiyotensin reseptör blokeri (ACE-I/ARB) (OR: 1.697, 95% CI: 1.124-2.562, p=0.012) ve mineralokortikoid reseptör antagonistleri (MRA) (OR: 1.511, 95% CI: 1.066-2.142, p=0.02) hiperkalemi için bağımsız faktörler olarak saptandı.

Sonuç: eGFR düzeyi, ACE-I/ARB ve MRA gerçek yaşam verilerinde kronik KY'de hiperkalemi ile ilişkili saptandı.

Anahtar Kelimeler

Hiperkalemi, Kalp yetmezliği, Potasyum, Renin-Anjiyotensin Sistemi.

Kaynakça

• 1. Rosano GMC, Tamargo J, Kjeldsen KP, Lainscak M, Agewall S, Anker SD, et al. Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother. 2018;4(3):180-188. doi: 10.1093/ehjcvp/pvy015.
• 2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891-975. doi: 10.1002/ejhf.592.
• 3. Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004;351(6):543-551. doi: 10.1056/NEJMoa040135.
• 4. Beusekamp JC, Tromp J, Cleland JGF, Givertz MM, Metra M, O'Connor CM, et al. Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality. JACC Heart Fail. 2019;7(11):970-979. doi: 10.1016/j.jchf.2019.07.010.
• 5. Ferreira JP, Mogensen UM, Jhund PS, Desai AS, Rouleau JL, Zile MR, et al. Serum potassium in the PARADIGM-HF trial. Eur J Heart Fail. 2020;22(11):2056-2064. doi: 10.1002/ejhf.1987
• 6. Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21. doi: 10.1056/NEJMoa1009492.
• 7. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709-717. doi: 10.1056/NEJM199909023411001.
• 8. Rossignol P, Lainscak M, Crespo-Leiro MG, Laroche C, Piepoli MF, Filippatos G, et al. Unravelling the interplay between hyperkalaemia, renin-angiotensin-aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry. Eur J Heart Fail. 2020;22(8):1378-1389. doi: 10.1002/ejhf.1793.
• 9. Collins AJ, Pitt B, Reaven N, Funk S, McGaughey K, Wilson D, et al. Association of Serum Potassium with All-Cause Mortality in Patients with and without Heart Failure, Chronic Kidney Disease, and/or Diabetes. Am J Nephrol. 2017;46(3):213-221. doi: 10.1159/000479802.
• 10. Aldahl M, Jensen AC, Davidsen L, Eriksen MA, Møller Hansen S, Nielsen BJ, et al. Associations of serum potassium levels with mortality in chronic heart failure patients. Eur Heart J. 2017;38(38):2890-2896. doi: 10.1093/eurheartj/ehx460.
• 11. Vardeny O, Claggett B, Anand I, Rossignol P, Desai AS, Zannad F, et al. Incidence, predictors, and outcomes related to hypo- and hyperkalemia in patients with severe heart failure treated with a mineralocorticoid receptor antagonist. Circ Heart Fail. 2014;7(4):573-579. doi: 10.1161/CIRCHEARTFAILURE.114.001104.
• 12. Rossignol P, Dobre D, McMurray JJ, Swedberg K, Krum H, van Veldhuisen DJ, et al. Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Circ Heart Fail. 2014;7(1):51-58. doi: 10.1161/CIRCHEARTFAILURE.113.000792.
• 13. Kovesdy CP. Epidemiology of hyperkalemia: an update. Kidney Int Suppl (2011). 2016;6(1):3-6. doi: 10.1016/j.kisu.2016.01.002.
• 14. de Denus S, Tardif JC, White M, Bourassa MG, Racine N, Levesque S, et al. Quantification of the risk and predictors of hyperkalemia in patients with left ventricular dysfunction: a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) trials. Am Heart J. 2006;152(4):705-712. doi: 10.1016/j.ahj.2006.05.030.
• 15. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 ;371(11):993-1004. doi: 10.1056/NEJMoa1409077.
• 16. Rossignol P, Zannad F, Pitt B; Writing group of 10th Global Cardio Vascular Clinical Trialist forum held on December 6th-7th 2013 in Paris, France. Time to retrieve the best benefits from renin angiotensin aldosterone system (RAAS) inhibition in heart failure patients with reduced ejection fraction: lessons from randomized controlled trials and registries. Int J Cardiol. 2014;177(3):731-733. doi: 10.1016/j.ijcard.2014.11.004. 17. Trevisan M, de Deco P, Xu H, Evans M, Lindholm B, Bellocco R, et al. Incidence, predictors and clinical management of hyperkalaemia in new users of mineralocorticoid receptor antagonists. Eur J Heart Fail. 2018;20(8):1217-1226. doi: 10.1002/ejhf.1199.
• 18. Bandak G, Sang Y, Gasparini A, Chang AR, Ballew SH, Evans M, et al. Hyperkalemia After Initiating Renin-Angiotensin System Blockade: The Stockholm Creatinine Measurements (SCREAM) Project. J Am Heart Assoc. 2017;6(7):e005428. doi: 10.1161/JAHA.116.005428.
• 19. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161. doi: 10.1161/CIR.0000000000000509.
• 20. Beusekamp JC, Tromp J, van der Wal HH, Anker SD, Cleland JG, Dickstein K, et al. Potassium and the use of renin-angiotensin-aldosterone system inhibitors in heart failure with reduced ejection fraction: data from BIOSTAT-CHF. Eur J Heart Fail. 2018;20(5):923-930. doi: 10.1002/ejhf.1079.
• 21. Lund LH, Pitt B. Is hyperkalaemia in heart failure a risk factor or a risk marker? Implications for renin-angiotensin-aldosterone system inhibitor use. Eur J Heart Fail. 2018;20(5):931-932. doi: 10.1002/ejhf.1175.
• 22. Savarese G, Carrero JJ, Pitt B, Anker SD, Rosano GMC, Dahlström U, et al. Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry. Eur J Heart Fail. 2018;20(9):1326-1334. doi: 10.1002/ejhf.1182.
• 23. Desai AS, Swedberg K, McMurray JJ, Granger CB, Yusuf S, Young JB, et al. Incidence and predictors of hyperkalemia in patients with heart failure: an analysis of the CHARM Program. J Am Coll Cardiol. 2007;50(20):1959-1966. doi: 10.1016/j.jacc.2007.07.067.
• 24. Minà C, Ajello L, Gesaro GD, Falletta C, Clemenza F. Hyperkalemia in heart failure: current treatment and new therapeutic perspectives. Rev Cardiovasc Med. 2020;21(2):241-252. doi: 10.31083/j.rcm.2020.02.8.