Ersilia M DeFilippis1, Akshay S Desai2,3. 1. Cardiovascular Division (ASD) and Department of Medicine (EMD, ASD), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. Cardiovascular Division (ASD) and Department of Medicine (EMD, ASD), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. adesai@partners.org. 3. Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. adesai@partners.org.
Abstract
PURPOSE OF REVIEW: The aim of this paper is to discuss strategies for prevention and management of hyperkalemia in patients with heart failure, including the role of novel therapies. RECENT FINDINGS: Renin-angiotensin-aldosterone system (RAAS) antagonists, including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) decrease mortality and morbidity in heart failure but increase the risk of hyperkalemia, especially when used in combination. Prevention of hyperkalemia and its associated complications requires careful patient selection, counseling regarding dietary potassium intake, awareness of drug interactions, and regular laboratory surveillance. Recent data suggests that the risk of hyperkalemia may be further moderated through the use of combined angiotensin-neprilysin inhibitors, novel MRAs, and novel potassium binding agents. Clinicians should be mindful of the risk of hyperkalemia when prescribing RAAS inhibitors to patients with heart failure. In patients at highest risk, such as those with diabetes, the elderly, and advanced chronic kidney disease, more intensive laboratory surveillance of potassium and creatinine may be required. Novel therapies hold promise for reducing the risk of hyperkalemia and enhancing the tolerability of RAAS antagonists.
PURPOSE OF REVIEW: The aim of this paper is to discuss strategies for prevention and management of hyperkalemia in patients with heart failure, including the role of novel therapies. RECENT FINDINGS: Renin-angiotensin-aldosterone system (RAAS) antagonists, including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) decrease mortality and morbidity in heart failure but increase the risk of hyperkalemia, especially when used in combination. Prevention of hyperkalemia and its associated complications requires careful patient selection, counseling regarding dietary potassium intake, awareness of drug interactions, and regular laboratory surveillance. Recent data suggests that the risk of hyperkalemia may be further moderated through the use of combined angiotensin-neprilysin inhibitors, novel MRAs, and novel potassium binding agents. Clinicians should be mindful of the risk of hyperkalemia when prescribing RAAS inhibitors to patients with heart failure. In patients at highest risk, such as those with diabetes, the elderly, and advanced chronic kidney disease, more intensive laboratory surveillance of potassium and creatinine may be required. Novel therapies hold promise for reducing the risk of hyperkalemia and enhancing the tolerability of RAAS antagonists.
Authors: Bertram Pitt; Marc A Pfeffer; Susan F Assmann; Robin Boineau; Inder S Anand; Brian Claggett; Nadine Clausell; Akshay S Desai; Rafael Diaz; Jerome L Fleg; Ivan Gordeev; Brian Harty; John F Heitner; Christopher T Kenwood; Eldrin F Lewis; Eileen O'Meara; Jeffrey L Probstfield; Tamaz Shaburishvili; Sanjiv J Shah; Scott D Solomon; Nancy K Sweitzer; Song Yang; Sonja M McKinlay Journal: N Engl J Med Date: 2014-04-10 Impact factor: 91.245
Authors: Matthew R Weir; George L Bakris; David A Bushinsky; Martha R Mayo; Dahlia Garza; Yuri Stasiv; Janet Wittes; Heidi Christ-Schmidt; Lance Berman; Bertram Pitt Journal: N Engl J Med Date: 2014-11-21 Impact factor: 91.245
Authors: Christopher B Granger; John J V McMurray; Salim Yusuf; Peter Held; Eric L Michelson; Bertil Olofsson; Jan Ostergren; Marc A Pfeffer; Karl Swedberg Journal: Lancet Date: 2003-09-06 Impact factor: 79.321
Authors: Gerasimos Filippatos; Stefan D Anker; Michael Böhm; Mihai Gheorghiade; Lars Køber; Henry Krum; Aldo P Maggioni; Piotr Ponikowski; Adriaan A Voors; Faiez Zannad; So-Young Kim; Christina Nowack; Giovanni Palombo; Peter Kolkhof; Nina Kimmeskamp-Kirschbaum; Alexander Pieper; Bertram Pitt Journal: Eur Heart J Date: 2016-04-29 Impact factor: 35.855
Authors: Agnieszka Gala-Błądzińska; Janusz Romanek; Danuta Mazur; Tomasz Stepek; Marcin Braun; Piotr Szafarz; Marcin Chlebuś; Andrzej Przybylski Journal: Cardiol Res Pract Date: 2020-03-21 Impact factor: 1.866