Pedro Caravaca Perez1,2, José R González-Juanatey1,3, Jorge Nuche1,4, Laura Morán Fernández1,2, David Lora Pablos5, Jesús Alvarez-García1,6, Ramón Bascompte Claret7, Manuel Martínez Selles1,8, Rafael Vázquez García9, Luis Martínez Dolz1,10, Marta Cobo-Marcos1,11, Domingo Pascual Figal1,12, Maria G Crespo-Leiro1,13, Julio Nuñez Villota1,14, Juan Cinca Cuscullola4, Juan F Delgado15,16,17. 1. CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. 2. Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Avenida de Andalucía s/n, 28041, Madrid, Spain. 3. Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Facultad de Medicina, Universidad de Santiago, Santiago de Compostela, Spain. 4. Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain. 5. Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Universidad Complutense de Madrid, CIBERESP, Madrid, Spain. 6. Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, Universidad de Barcelona, Barcelona, Spain. 7. Hospital Universitari Arnau de Vilanova, IBRLLEIDA, Lleida, Spain. 8. Department of Cardiology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria IiGM, Universidad Europea, Madrid, Spain. 9. UGC de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain. 10. Department of Cardiology, Hospital Universitario Y Politécnico La Fe, IIS La Fe, Valencia, Spain. 11. Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. 12. Department of Cardiology, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, Murcia, Spain. 13. Department of Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomedica A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain. 14. Servicio de Cardiología, Hospital Clinico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain. 15. CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. juan.delgado@salud.madrid.org. 16. Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Avenida de Andalucía s/n, 28041, Madrid, Spain. juan.delgado@salud.madrid.org. 17. Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain. juan.delgado@salud.madrid.org.
Abstract
BACKGROUND: Available information about prognostic implications of potassium levels alteration in the setting of acute heart failure (AHF) is scarce. OBJECTIVES: We aim to describe the prevalence of dyskalemia (hypo or hyperkalemia), its dynamic changes during AHF-hospitalization, and its long-term clinical impact after hospitalization. METHODS: We analyzed 1779 patients hospitalized with AHF who were included in the REDINSCOR II registry. Patients were classified in three groups, according to potassium levels both on admission and discharge: hypokalemia (potassium < 3.5 mEq/L), normokalemia (potassium = 3.5-5.0 mEq/L and, hyperkalemia (potassium > 5 mEq/L). RESULTS: The prevalence of hypokalemia and hyperkalemia on admission was 8.2 and 4.6%, respectively, and 6.4 and 2.7% at discharge. Hyperkalemia on admission was associated with higher in-hospital mortality (OR = 2.32 [95% CI: 1.04-5.21] p = 0.045). Among patients with hypokalemia on admission, 79% had normalized potassium levels at discharge. In the case of patients with hyperkalemia on admission, 89% normalized kalemia before discharge. In multivariate Cox regression, dyskalemia was associated with higher 12-month mortality, (HR = 1.48 [95% CI, 1.12-1.96], p = 0.005). Among all patterns of dyskalemia persistent hypokalemia (HR = 3.17 [95% CI: 1.71-5.88]; p < 0.001), and transient hyperkalemia (HR = 1.75 [95% CI: 1.07-2.86]; p = 0.023) were related to reduced 12-month survival. CONCLUSIONS: Potassium levels alterations are frequent and show a dynamic behavior during AHF admission. Hyperkalemia on admission is an independent predictor of higher in-hospital mortality. Furthermore, persistent hypokalemia and transient hyperkalemia on admission are independent predictors of 12-month mortality.
BACKGROUND: Available information about prognostic implications of potassium levels alteration in the setting of acute heart failure (AHF) is scarce. OBJECTIVES: We aim to describe the prevalence of dyskalemia (hypo or hyperkalemia), its dynamic changes during AHF-hospitalization, and its long-term clinical impact after hospitalization. METHODS: We analyzed 1779 patients hospitalized with AHF who were included in the REDINSCOR II registry. Patients were classified in three groups, according to potassium levels both on admission and discharge: hypokalemia (potassium < 3.5 mEq/L), normokalemia (potassium = 3.5-5.0 mEq/L and, hyperkalemia (potassium > 5 mEq/L). RESULTS: The prevalence of hypokalemia and hyperkalemia on admission was 8.2 and 4.6%, respectively, and 6.4 and 2.7% at discharge. Hyperkalemia on admission was associated with higher in-hospital mortality (OR = 2.32 [95% CI: 1.04-5.21] p = 0.045). Among patients with hypokalemia on admission, 79% had normalized potassium levels at discharge. In the case of patients with hyperkalemia on admission, 89% normalized kalemia before discharge. In multivariate Cox regression, dyskalemia was associated with higher 12-month mortality, (HR = 1.48 [95% CI, 1.12-1.96], p = 0.005). Among all patterns of dyskalemia persistent hypokalemia (HR = 3.17 [95% CI: 1.71-5.88]; p < 0.001), and transient hyperkalemia (HR = 1.75 [95% CI: 1.07-2.86]; p = 0.023) were related to reduced 12-month survival. CONCLUSIONS: Potassium levels alterations are frequent and show a dynamic behavior during AHF admission. Hyperkalemia on admission is an independent predictor of higher in-hospital mortality. Furthermore, persistent hypokalemia and transient hyperkalemia on admission are independent predictors of 12-month mortality.
Authors: Francesc Formiga; David Chivite; Xavier Corbella; Alicia Conde-Martel; José Carlos Arévalo-Lorido; Joan Carles Trullàs; José Pérez Silvestre; Sara Carrascosa García; Luis Manzano; Manuel Montero-Pérez-Barquero Journal: Eur J Intern Med Date: 2018-10-26 Impact factor: 4.487
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Authors: Pedro Caravaca Perez; José R González-Juanatey; Jorge Nuche; Jose M Guerra; Manuel Martínez Selles; Juan F Delgado Journal: Clin Res Cardiol Date: 2021-01-21 Impact factor: 5.460
Authors: Juan F Delgado-Jiménez; Javier Segovia-Cubero; Luis Almenar-Bonet; Javier de Juan-Bagudá; Antonio Lara-Padrón; José Manuel García-Pinilla; Juan Luis Bonilla-Palomas; Silvia López-Fernández; Sonia Mirabet-Pérez; Inés Gómez-Otero; Antonio Castro-Fernández; Beatriz Díaz-Molina; Josebe Goirigolzarri-Artaza; Luis Miguel Rincón-Díaz; Domingo Andrés Pascual-Figal; Manuel Anguita-Sánchez; Javier Muñiz; María G Crespo-Leiro Journal: J Clin Med Date: 2022-02-22 Impact factor: 4.241