Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure

Formiga, Francesç; Chivite, David; Corbella, Xavier; Conde-Martel, Alicia; Arévalo-Lorido, José Carlos; Trullàs, Joan Carles; Silvestre, Julio; García, Sara Carrascosa; Manzano, Luís; Montero-Pérez-Barquero, Manuel

doi:10.1016/j.ejim.2018.10.016

Cited by 18 publications

(14 citation statements)

References 28 publications

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“…The early recognition and treatment of hyperkalemia is essential, because this condition, although often clinically silent, may have severe consequences. Hyperkalemia is associated with poor outcomes and high mortality rates, both in the general population and in different clinical settings, including patients with cardiac and renal diseases and critically ill patients [30,31]. Moreover, hyperkalemia has been described as an independent predictor of mortality in patients admitted to the ED [32].…”

Section: Hyperkalemia: Physiopathology Risk Factors Clinical Conseqmentioning

confidence: 99%

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Esposito

Conti

Falqui

et al. 2020

JCM

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Hyperkalemia may cause life-threatening cardiac and neuromuscular alterations, and it is associated with high mortality rates. Its treatment includes a multifaceted approach, guided by potassium levels and clinical presentation. In general, treatment of hyperkalemia may be directed towards stabilizing cell membrane potential, promoting transcellular potassium shift and lowering total K+ body content. The latter can be obtained by dialysis, or by increasing potassium elimination by urine or the gastrointestinal tract. Until recently, the only therapeutic option for increasing fecal K+ excretion was represented by the cation-exchanging resin sodium polystyrene sulfonate. However, despite its common use, the efficacy of this drug has been poorly studied in controlled studies, and concerns about its safety have been reported. Interestingly, new drugs, namely patiromer and sodium zirconium cyclosilicate, have been developed to treat hyperkalemia by increasing gastrointestinal potassium elimination. These medications have proved their efficacy and safety in large clinical trials, involving subjects at high risk of hyperkalemia, such as patients with heart failure and chronic kidney disease. In this review, we discuss the mechanisms of action and the updated data of patiromer and sodium zirconium cyclosilicate, considering that the availability of these new treatment options offers the possibility of improving the management of both acute and chronic hyperkalemia.

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Section: Hyperkalemia: Physiopathology Risk Factors Clinical Conseqmentioning

confidence: 99%

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Esposito

Conti

Falqui

et al. 2020

JCM

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“…With respect to the literature, hyperkalemia was reported to increase risk for mortality and readmission in patients hospitalized for HF [21] and was strongly associated with reduced renal function [23,24]. Additionally, an increased risk for HF hospitalization was reported after an event of hyperkalemia [23].…”

Section: Potassiummentioning

confidence: 99%

“…Conditions such as arrhythmia, worsening renal function, and infections [12,13] are common complications in patients suffering from HF and were described to be precipitating factors for HF hospitalization [3,[14][15][16][17][18]. Additionally, electrolyte imbalances appear frequently in HF patients [19][20][21][22], especially as several drugs commonly used in heart failure treatment may lead to hypo-or hyperkalemia, respectively [23,24]. Although prescription of potassium supplements was previously described to be associated with HF hospitalization in the long-term [22], and "infection" is reported to be a common precipitating factor, neither prescriptions of potassium nor amoxicillin/clavulanic acid have been assessed as acute risk factors for heart failure hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data

Jödicke

Burden

Zellweger

et al. 2020

Eur J Clin Pharmacol

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Purpose Heart failure is among the leading causes for hospitalization in Europe. In this study, we evaluate potential precipitating factors for hospitalization for heart failure and shock. Methods Using Swiss claims data (2014-2015), we evaluated the association between hospitalization for heart failure and shock, and prescription of oral potassium supplements, non-steroidal anti-inflammatory drugs (NSAIDs), and amoxicillin/clavulanic acid. We conducted case-crossover analyses, where exposure was compared for the hazard period and the primary control period (e.g., 1-30 days before hospitalization vs. 31-60 days, respectively). Conditional logistic regression was applied and subsequently adjusted for addressing potential confounding by disease progression. Sensitivity analyses were conducted and stratification for co-medication was performed. Results We identified 2185 patients hospitalized with heart failure or shock. Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid was significantly associated with an increased risk for hospitalization for heart failure and shock with crude odds ratios (OR) of 2.04 for potassium (95% CI 1.24-3.36, p = 0.005, 30 days), OR 1.8 for NSAIDs (95% CI 1.39-2.33, p < 0.0001, 30 days), and OR 3.25 for amoxicillin/clavulanic acid (95% CI 2.06-5.14, p < 0.0001, 15 days), respectively. Adjustment attenuated odds ratios, while the significant positive association remained (potassium OR 1.70 (95% CI 1.01-2.86, p = 0.046), NSAIDs OR 1.50 (95% CI 1.14-1.97, p = 0.003), and amoxicillin/clavulanic acid OR 2.26 (95% CI 1.41-3.62, p = 0.001). Conclusion Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid is associated with increased risk for hospitalization. Underlying conditions such as pain, electrolyte imbalances, and infections are likely contributing risk factors. Physicians may use this knowledge to better identify patients at risk and adapt patient management.

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“…Údajov o frekvencii dyskaliémií u seniorov a ich vzťahu k farmakoterapii nie je priveľa. V španielskom registri srdcového zlyhania (2 865 pacientov > 74 rokov, priemerný vek 83 rokov) malo spomedzi hospitalizovaných pre akútne srdcové zlyhanie hypokaliémiu/hyperkaliémiu (< 3,5 / > 5,5 mmol/l) 6,1 / 3,4 % (14). Údaje o starších pacientoch (≥ 60 rokov, priemerného veku 77 rokov, n = 566) s chronickým srdcovým enzýmu konvertujúceho angiotenzín, ARB -blokátor angiotenzínového receptora, ASA -kyselina acetylsalicylová, BB -betablokátor iný ako sotalol, CI -95-percentný interval spoľahlivosti, Diuretiká -diuretiká iné ako spironolaktón, "i" index -užívané pri príjme, LMWH -heparín s nízkou molekulovou hmotnosťou, NSA -nesteroidné antiflogistikum/antireumatikum, "o" index -užívané pri prepustení, OR -"odds ratio -pomer šancí", RAAS -užívanie aspoň jedného liečiva spomedzi inhibítorov enzýmu konvertujúceho angiotenzín, blokátorov angiotenzínového receptora alebo spironolaktónu, Th 3+ -užívanie najmenej troch potenciálne hyperkaliemizujúcich liečiv zlyhaním sú k dispozícii napríklad z USA: hyperkaliémia > 5,5 mm/l sa v priebehu 18 mesiacov vyskytla v 13,4 % intenzívne liečených pacientov (15).…”

Section: Diskusiaunclassified