Hyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review

Fonseca, Cândida; Brito, Dulce; Branco, Patrícia; Frazão, João; Silva-Cardoso, José; Bettencourt, Paulo

doi:10.1016/j.repc.2020.03.015

Cited by 10 publications

(11 citation statements)

References 79 publications

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“…A systematic review finds an association between treatment with RASi and hyperkalemia. Although the study focuses on patients with chronic heart failure, whereas our study focuses on hypertension with comorbidities such as heart failure, it also mentions that patients with advanced stages of chronic kidney disease, diabetes, and resistant hypertension have a higher risk of developing hyperkalemia (19). A case report study concludes that hyperkalemia induced by beta-adrenergic receptor blockade can occur in 1-5% of patients, and further indicates a higher risk of it occurring in non-cardio-selective BB than in cardio-selective BB (20).…”

Section: Bb and Rasimentioning

confidence: 99%

Risk of developing hyperkalemia in patients with hypertension treated with combination antihypertensive therapy – a retrospective register-based study

Moussa,

Al-Janabi,

Taleb

et al. 2023

Preprint

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Background The risk of hyperkalemia in relation to different combinations of antihypertensive therapy remains to be elucidated.Methods In this Danish register-based study, we aimed to investigate the risk of developing hyperkalemia in relation to different combinations of antihypertensive therapy. Using incidence density matching, we matched a hyperkalemic patient to five normokalemic patients on renal function, age, sex, and time between study entry and date of potassium measurement. Combination therapies were subdivided into eight groups: beta blockers (BB) + calcium channel blockers (CCB), BB + renin angiotensin system inhibitors (RASi), BB + RASi + mineralocorticoid receptor antagonists (MRA), CCB + RASi, CCB + RASi + thiazides, CCB + thiazides, RASi + thiazides, and other combinations. Multivariable conditional logistic regression was used to estimate the odds of hyperkalemia within 90 days for each of the eight antihypertensive combination therapies.Results A total of 793 patients with hyperkalemia were matched to 3,788 normokalemic patients. In multivariable analysis, odds of developing hyperkalemia when being treated with BB + RASi + MRA was 2.58 (95% CI, 1.87–3.56) compared to RASi + thiazides (reference). Another significant association with other combinations that indicated a strong association with increased hyperkalemia was seen for the BB + RASi combination (OR, 1.55 [95% CI, 1.21-2.00]). Combinations including CCB + RASi (OR, 1.00 [95% CI, 0.76–1.32]) and CCB + RASi + thiazides (OR, 0.85 [95% CI, 0.54–1.34]) were not significantly associated with hyperkalemia.Conclusion Combinations of BB + RASi, with and without MRA were significantly associated with an increased risk of developing hyperkalemia within 90 days of initiating treatment.

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Section: Bb and Rasimentioning

confidence: 99%

Risk of developing hyperkalemia in patients with hypertension treated with combination antihypertensive therapy – a retrospective register-based study

Moussa,

Al-Janabi,

Taleb

et al. 2023

Preprint

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Section: объективные ограничения для назначения и титрования омт при снunclassified

“…Частота гиперкалиемии при СН достигает 30 % в рандомизированных исследованиях [46,47] и 63 % по данным реальной клинической практики и ассоциируется с назначением иРААС, пожилым возрастом, сахарным диабетом и хронической болезнью почек [46]. Дозы ОБЗОРЫ § иРААС снижаются в 3-22 % случаев лечения СНнФВ, в 5 % случаев -вследствие гиперкалиемии [46]. Однако данные европейского регистра The ESC-HFA-EORP Heart Failure Long-Term Registry свидетельствуют, что в широкой популяции пациентов с СН только прекращение терапии иРААС ассоциировано с риском смерти, в то время как гиперкалиемия теряет прогностическую значимость в многофакторном анализе [48].…”

Section: объективные ограничения для назначения и титрования омт при снunclassified

Decompensated heart failure with reduced ejection fraction: overcoming barriers to improve prognosis in the “vulnerable” period after discharge

Villevalde

Soloveva

2021

Kardiologiia

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Frequency of hospitalizations for decompensated heart failure (HF) and associated costs are steadily increasing worldwide. An episode of HF is a risk marker, reflects a change in the course of disease, a high probability of adverse events, and requirement for using all options to improve the prognosis. This article discusses barriers and ways to overcome them in managing HF patients with low ejection fraction. An evidence-based, disease-modifying therapy exists for this HF phenotype. Administration of the therapy along with additional, novel drugs that improve outcomes, and organization of medical care are essential during the “vulnerable period” after discharge from the hospital.

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“…Hyperkalemia is a frequent electrolyte disorder in patients with chronic kidney disease (CKD) [1], which can lead to life-threatening cardiac arrhythmias and sudden cardiac death [2][3][4][5]. Major risk factors for hyperkalemia include the use of renin-angiotensin-aldosterone system inhibitors (RAASis), core therapeutic options to prevent CKD progression, and cardiovascular events [6,7].…”

Section: Introductionmentioning

confidence: 99%

Discontinuation of Renin-Angiotensin-Aldosterone System Inhibitors Secondary to Hyperkalemia Translates into Higher Cardiorenal Outcomes

An,

Zhou,

et al. 2023

Am J Nephrol

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Introduction: Discontinuation of renin-angiotensin-aldosterone system inhibitor (RAASi) is common after hyperkalemia. We evaluated the risk of kidney and mortality outcomes associated with RAASi discontinuation among patients with chronic kidney disease (CKD) and hyperkalemia. Methods: We identified adult patients with CKD (eGFR <60 mL/min/1.73 m2) who experienced new-onset hyperkalemia (potassium ≥5.0 mEq/L) between 2016 and 2017 from Kaiser Permanente Southern California and followed them through 2019. We defined treatment discontinuation as having ≥90-day gap in refills of all RAASi within 3 months after hyperkalemia. We used multivariable Cox proportional hazards models to evaluate the association between RAASi discontinuation and the primary composite outcome of kidney (≥40% eGFR decline, dialysis, kidney transplant) or all-cause mortality. We evaluated cardiovascular events and recurrence of hyperkalemia as secondary outcomes. Results: Among 5,728 patients (mean age 76 years), 13.5% discontinued RAASi within 3 months after new-onset hyperkalemia. During the median 2 years of follow-up, 29.7% had the primary composite outcome (15.5% with ≥40% eGFR decline, 2.8% dialysis or kidney transplant, 18.4% all-cause mortality). Patients who discontinued RAASi had a higher all-cause mortality compared with those who continued RAASi (26.7% vs. 17.1%) but had no differences in kidney outcomes, cardiovascular events, and recurrence of hyperkalemia. RAASi discontinuation was associated with a higher risk of kidney or all-cause mortality composite outcome (adjusted hazard ratio [aHR] 1.21, 95% CI: 1.06, 1.37) mainly driven by all-cause mortality (aHR: 1.34, 95% CI: 1.14, 1.56). Conclusion: RAASi discontinuation after hyperkalemia was associated with worsened mortality, which may underscore the benefits of continuing RAASi among patients with CKD.

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Hyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review

Cited by 10 publications

References 79 publications

Risk of developing hyperkalemia in patients with hypertension treated with combination antihypertensive therapy – a retrospective register-based study

Risk of developing hyperkalemia in patients with hypertension treated with combination antihypertensive therapy – a retrospective register-based study

Decompensated heart failure with reduced ejection fraction: overcoming barriers to improve prognosis in the “vulnerable” period after discharge

Discontinuation of Renin-Angiotensin-Aldosterone System Inhibitors Secondary to Hyperkalemia Translates into Higher Cardiorenal Outcomes

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