Serum potassium and heart failure: association, causation, and clinical implications

Sfairopoulos, Dimitrios; Arseniou, Angelos; Korantzopoulos, Panagiotis

doi:10.1007/s10741-020-10039-9

Cited by 16 publications

(12 citation statements)

References 51 publications

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“…The hypokalaemia reduction is notable because it is causatively associated with adverse outcomes in heart failure. 29 Although this prespecified pooled analysis of two studies with similar protocols included a large patient population with CKD and type 2 diabetes, limitations are that it did not include patients with nonalbuminuric CKD and only a small proportion of Black patients were included. Since the design of the FIGARO-DKD and FIDELIO-DKD studies, SGLT-2 inhibitors have emerged as therapeutic options for patients with CKD and type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis

Agarwal

Filippatos

Pitt

et al. 2021

European Heart Journal

577

354

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Aims The complementary studies FIDELIO-DKD and FIGARO-DKD in patients with type 2 diabetes and chronic kidney disease (CKD) examined cardiovascular and kidney outcomes in different, overlapping stages of CKD. The purpose of the FIDELITY analysis was to perform an individual patient-level prespecified pooled efficacy and safety analysis across a broad spectrum of CKD to provide more robust estimates of safety and efficacy of finerenone compared with placebo. Methods and results For this prespecified analysis, two phase III, multicentre, double-blind trials involving patients with CKD and type 2 diabetes, randomized 1:1 to finerenone or placebo, were combined. Main time-to-event efficacy outcomes were a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure, and a composite of kidney failure, a sustained ≥57% decrease in estimated glomerular filtration rate from baseline over ≥4 weeks, or renal death. Among 13 026 patients with a median follow-up of 3.0 years (interquartile range 2.3–3.8 years), the composite cardiovascular outcome occurred in 825 (12.7%) patients receiving finerenone and 939 (14.4%) receiving placebo [hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.78–0.95; P = 0.0018]. The composite kidney outcome occurred in 360 (5.5%) patients receiving finerenone and 465 (7.1%) receiving placebo (HR, 0.77; 95% CI, 0.67–0.88; P = 0.0002). Overall safety outcomes were generally similar between treatment arms. Hyperkalaemia leading to permanent treatment discontinuation occurred more frequently in patients receiving finerenone (1.7%) than placebo (0.6%). Conclusion Finerenone reduced the risk of clinically important cardiovascular and kidney outcomes vs. placebo across the spectrum of CKD in patients with type 2 diabetes. Key Question Does finerenone, a novel selective, nonsteroidal mineralocorticoid receptor antagonist, added to maximum tolerated renin–angiotensin system inhibition reduce cardiovascular disease and kidney disease progression over a broad range of chronic kidney disease in patients with type 2 diabetes? Key Finding In a prespecified, pooled individual-level analysis from two randomized trials, we found reductions both in cardiovascular events and kidney failure outcomes with finerenone. Because 40% of the patients had an estimated glomerular filtration rate of >60 mL/min/1.73m2 they were identified solely on the basis of albuminuria. Take Home Message Finerenone reduces the risk of clinical cardiovascular outcomes and kidney disease progression in a broad range of patients with chronic kidney disease and type 2 diabetes. Screening for albuminuria to identify at-risk patients among patients with type 2 diabetes facilitates reduction of both cardiovascular and kidney disease burden.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis

Agarwal

Filippatos

Pitt

et al. 2021

European Heart Journal

577

354

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“…Both hypokalaemia and hyperkalaemia have been associated with a poor outcome in patients with HF. However, it is not known if this association is causal 14 . The main findings of the study were as follows.…”

Section: Discussionmentioning

confidence: 92%

“…However, it is not known if this association is causal. 14 The main findings of the study were as follows. First, disturbances in potassium homeostasis are prevalent among critically ill patients presenting with HF.…”

Section: Discussionmentioning

confidence: 97%

Assessing potassium levels in critically ill patients with heart failure: application of a group‐based trajectory model

et al. 2022

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Aims Abnormalities in potassium homeostasis are frequently seen in hospitalized patients. A poor outcome in heart failure (HF) has been linked to both hypokalaemia and hyperkalaemia. The studies on the connection between variations in potassium levels and all‐cause mortality remain scarce. We delineated trajectories of potassium levels and investigated the association of these trajectories with all‐cause mortality of critically ill patients with HF. Methods and results A retrospective analysis of blood potassium levels (9 times) in patients with HF after being admitted to the intensive care unit (ICU). Potassium levels were divided into three groups according to the first serum potassium level in ICU and thereafter categorized as follows: hypokalaemia group ( n = 336) (<3.5 mmol/L), normal blood potassium‐level group ( n = 3322) (3.5–5.0 mmol/L), and hyperkalaemia group ( n = 395) (>5.0 mmol/L). According to the group‐based trajectory modelling (GBTM), the hyperkalaemia group and the normal blood potassium‐level group can be divided into three trajectory groups: the low‐level stable group, the medium‐level stable group, and the high‐level decline group. The hypokalaemia group can be divided into two trajectory groups: the low‐level rise group and the high‐level rise group. A total of 4053 HF patients were included (mean age 71.81 ± 13.12 years, 54.90% males, 45.10% females). After adjusting for possible confounding variables, in the hyperkalaemia group, the low‐level stable group had lower 28 day [high‐level decline group vs. low‐level stable group hazard ratio (HR), 95% confidence interval (CI): 2.917, 1.555–5.473; P < 0.05] and 365 day (high‐level decline group vs. low‐level stable group HR, 95% CI: 2.854, 1.820–4.475; P < 0.05) all‐cause mortality. In the normal blood potassium‐level group, the medium‐level stable group had lower 28 day (medium‐level stable group vs. low‐level stable group HR, 95% CI: 0.776, 0.657–0.918; P < 0.05) and 365 day (medium‐level stable group vs. low‐level stable group HR, 95% CI: 0.827, 0.733–0.934; P < 0.05) all‐cause mortality. In the hypokalaemia group, the cumulative survival of the high‐level rise group and the low‐level rise group did not differ significantly. Conclusions Critically ill patients with HF have blood potassium trajectories. And the trajectories are associated with all‐cause mortality for hyperkalaemia and normal blood potassium‐level patients. GBTM is a granular method to describe the evolution of blood potassium, which may increase the current knowledge of blood potassium‐level adjustment.

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“…Hypokalemia is prevalent in CHF [4]. It may be attributed to the underlying cardiac disease, pharmacological intervention to manage heart failure, especially diuretics, and associated illnesses [10]. There is data to suggest that hypokalemia affects the cardiac electrical stability in multiple mechanisms which include 1) direct pro-arrhythmogenic effects on ventricular muscle cells, 2) potentiation of medication-induced arrhythmias, for instance, digitalis-induced cardiac toxicity, pro-arrhythmic effects of sympathomimetics, QT prolongation with other QT-prolonging agents (e.g., fluoroquinolones antibiotics), and 3) potentiation of cardiac arrhythmia in the setting of structural cardiac abnormalities (e.g., ischemic heart disease and left ventricular dilatation) [11].…”

Section: Discussionmentioning

confidence: 99%

Hypokalemia-Induced Life-Threatening Arrhythmia in a Patient With Congestive Heart Failure

Fargaly¹,

Schultz²,

Chung³

et al. 2023

Cureus

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Ventricular tachyarrhythmias are common in patients with heart failure. It is one of the important preventable causes of death in these patient populations. Hypokalemia is prevalent in patients with heart failure due to various reasons. Hypokalemia can trigger ventricular arrhythmias through different mechanisms. In this case report, we present a middle-aged man with congestive heart failure (CHF) and an automated intracardiac defibrillator (AICD) on multiple diuretic medications (unintended) who presented with acute chest pain. He was found to have severe hypokalemia, hyponatremia, and an acute kidney injury. Interrogation of the AICD revealed multiple episodes of ventricular fibrillation. The patient was managed by holding his diuretic medications, cautious volume repletion, and potassium replacement. Fortunately, the patient showed rapid clinical improvement and his plasma potassium level improved. On discharge, we reconciled the patient's medications to avoid the recurrence of hypokalemia from over-diuresis and arranged a close follow-up outpatient visit with his cardiologist.

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Serum potassium and heart failure: association, causation, and clinical implications

Cited by 16 publications

References 51 publications

Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis

Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis

Assessing potassium levels in critically ill patients with heart failure: application of a group‐based trajectory model

Hypokalemia-Induced Life-Threatening Arrhythmia in a Patient With Congestive Heart Failure

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