[Hyperkalemia in heart failure: etiology, epidemiology and prognosis]

G Ital Cardiol (Rome). 2021 Dec;22(12 Suppl 1):e3-e7. doi: 10.1714/3716.37067.
[Article in Italian]

Abstract

Hyperkalemia (HK) is a common condition among heart failure (HF) patients, either due to their comorbidities, such as chronic renal failure, or due to the administration of therapies capable of promoting an increase in serum potassium (K+), such as renin-angiotensin-aldosterone system inhibitors (RAASi). RAASi are among the most important treatments for HF, especially in patients with reduced ejection fraction. This class of drugs, acting on the neurohormonal mechanisms, that lead to the worsening of hemodynamic compensation, has shown to improve the prognosis of HF patients, both in terms of mortality and HF hospitalizations. HK is a major cause of dose reduction, or even discontinuation, of RAASi, thus, indirectly worsening HF patient's prognosis. Pharmacological strategies for HK treatment in outpatients have long been based solely on therapies of dubious efficacy, such as sodium polystyrene sulfonate, which are difficult to administer in an extended period of time. Reasonably, the use of the new K+ binders (patiromer and sodium zirconium cyclosilicate) in clinical practice, allowing to reduce serum K+ levels without discontinuing RAASi therapy, will improve the prognosis of patients with HK and HF.

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors
  • Heart Failure* / drug therapy
  • Heart Failure* / epidemiology
  • Heart Failure* / etiology
  • Humans
  • Hyperkalemia* / epidemiology
  • Hyperkalemia* / etiology
  • Hyperkalemia* / therapy
  • Prognosis
  • Renal Insufficiency, Chronic*
  • Renin-Angiotensin System

Substances

  • Angiotensin-Converting Enzyme Inhibitors