Safety and efficacy of new potassium binders on hyperkalemia management in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials

Carvalho, Pedro E P; Veiga, Thiago M. A.; Lacerda, Henrique; Tofanelli, Matheus R.; Gewehr, Douglas M; Nunes, Maria Carmo P.; Silva, Ana Cristina Simões e

doi:10.1007/s00392-023-02215-2

Cited by 8 publications

(4 citation statements)

References 40 publications

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“…Carvalho et al and Montagnani et al are in line with our findings regarding MRA optimization. 37,38 Also, Carvalho et al showed the same findings regarding all other outcomes, 38 with Montagnani et al focusing on MRA optimization only. 37 However, none of them reported pooled analysis on ACEi/ ARB/ANRi optimization.…”

mentioning

confidence: 73%

“…are in line with our findings regarding MRA optimization. 37 , 38 Also, Carvalho et al . showed the same findings regarding all other outcomes, 38 with Montagnani et al .…”

Section: Discussionmentioning

confidence: 99%

“… 37 , 38 Also, Carvalho et al . showed the same findings regarding all other outcomes, 38 with Montagnani et al . focusing on MRA optimization only.…”

Section: Discussionmentioning

confidence: 99%

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The efficacy and safety of new potassium binders on renin–angiotensin–aldosterone system inhibitor optimization in heart failure patients: a systematic review and meta‐analysis

Abuelazm,

Badr,

Turkmani

et al. 2023

ESC Heart Failure

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Guideline‐directed medical therapy (GDMT) has improved outcomes in patients with heart failure, including the use of renin–angiotensin–aldosterone system inhibitors, which can hinder the excretion of potassium, resulting in hyperkalaemia. New potassium binders (NPBs) can prevent this adverse effect; however, the efficacy and safety of NPB for this indication have not been fully established. We conducted a systematic review and meta‐analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, Web of Science, Scopus, and Cochrane through 26 April 2023. The risk of bias assessment was conducted, following Cochrane's updated Risk of Bias 2 assessment tool. We used the fixed‐effects model to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI) (PROSPERO ID: CRD42023426113). We included six RCTs with a total of 1432 patients. NPB was significantly associated with successful mineralocorticoid receptor antagonist (MRA) optimization [RR: 1.13 with 95% CI (1.02–1.25), P = 0.02], decreased patients with MRA at less than the target dose [RR: 0.72 with 95% CI (0.57–0.90), P = 0.004], and decreased hyperkalaemic episodes [RR: 0.42 with 95% CI (0.24–0.72), P = 0.002]. However, there was no difference between NPB and placebo regarding angiotensin‐converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin receptor/neprilysin inhibitor (ANRi) optimization [RR: 1.02 with 95% CI (0.89–1.17), P = 0.76] and serum potassium change [MD: −0.31 with 95% CI (−0.61 to 0.00), P = 0.05], with an acceptable safety profile except for the increased incidence of hypokalaemia with NPB [RR: 1.57 with 95% CI (1.12–2.21), P = 0.009]. NPB has been shown to improve GDMT outcomes by enhancing MRA optimization and reducing hyperkalaemic episodes. However, there are limited data on the effects of NPB on ACEi/ARB/ANRi optimization. Future RCTs should investigate ACEi/ARB/ANRi optimization and conduct head‐to‐head comparisons of NPB (patiromer and sodium zirconium cyclosilicate).

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confidence: 73%

“…are in line with our findings regarding MRA optimization. 37 , 38 Also, Carvalho et al . showed the same findings regarding all other outcomes, 38 with Montagnani et al .…”

Section: Discussionmentioning

confidence: 99%

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The efficacy and safety of new potassium binders on renin–angiotensin–aldosterone system inhibitor optimization in heart failure patients: a systematic review and meta‐analysis

Abuelazm,

Badr,

Turkmani

et al. 2023

ESC Heart Failure

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“…New potassium binders now make it possible to reduce the risk of hyperkalemia and to maintain HF patients on the highest tolerated dose of MRA and/or RAS blockers [21]. A recent review and meta-analysis of published studies has confirmed that the use of potassium binders increases the rate of medical therapy optimization with RAS blockers and reduces the incidence of hyperkalemia [22]. However, among new binders, zirconium cyclosilicate should be avoided in patients with peripheral edema and/or congestion because it brings a lot of sodium and can aggravate peripheral edema.…”

Section: Steroidal and Non-steroidal Mineralocorticoid Receptor Antag...mentioning

confidence: 99%

How to optimize the use of diuretics in patients with heart failure?

Burnier,

Narkiewicz,

Kjeldsen

2023

Kardiol Pol

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Considering the pathophysiology and clinical presentation of heart failure, using diuretics or drugs with diuretic properties is indispensable for adequate management of heart failure patients. However, in clinical practice, fluid expansion is often undiagnosed, and diuretic therapy is not always adequately titrated. Today, several drug classes with diuretic properties are available in addition to classical thiazides, thiazide-like, and loop diuretics. The purpose of this short review is to discuss different ways to optimize diuretic therapy using currently available drugs. Several approaches are considered, including a combination of diuretics to obtain a sequential nephron blockade, use of a drug combining a blocker of the renin-angiotensin system (RAS) and an inhibitor of the metabolism of natriuretic peptides (ARNI), prescription of potassium binders to maintain and up-titrate RAS blockers and mineralocorticoid antagonists, and finally use of inhibitors of renal reabsorption of glucose through the sodium-glucose cotransporter 2 system. Optimal use of these various drug classes should improve the quality of life and reduce the need for hospital admissions and mortality in heart failure patients.

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Aortic regurgitation is associated with African American and Asian race, smoking, renal disease, and numerous autoimmune diseases in addition to traditional cardiovascular risk factors but has lower risk with alcohol intake

Timmerman,

Hashemzadeh,

Movahed

2024

Clin Res Cardiol

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Safety and efficacy of new potassium binders on hyperkalemia management in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials

Cited by 8 publications

References 40 publications

The efficacy and safety of new potassium binders on renin–angiotensin–aldosterone system inhibitor optimization in heart failure patients: a systematic review and meta‐analysis

The efficacy and safety of new potassium binders on renin–angiotensin–aldosterone system inhibitor optimization in heart failure patients: a systematic review and meta‐analysis

How to optimize the use of diuretics in patients with heart failure?

Aortic regurgitation is associated with African American and Asian race, smoking, renal disease, and numerous autoimmune diseases in addition to traditional cardiovascular risk factors but has lower risk with alcohol intake

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