Serum potassium and heart failure: association, causation, and clinical implications
- PDF / 783,527 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 13 Downloads / 173 Views
Serum potassium and heart failure: association, causation, and clinical implications Dimitrios Sfairopoulos1 · Angelos Arseniou1 · Panagiotis Korantzopoulos1 Accepted: 7 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Dyskalemia (hypo- and hyperkalemia) is a common clinical encounter in patients with heart failure (HF), linked to underlying pathophysiologic alterations, pharmacological treatments, and concomitant comorbidities. Both hypo- and hyperkalemia have been associated with a poor outcome in HF. However, it is not known if this association is causal. In order to investigate this relation, we implemented the Bradford Hill criteria for causation examining the available literature. Of note, hypokalemia and low-normal potassium levels (serum potassium 5.0 mmol/L) and adverse clinical outcomes in HF appears unlikely. We also examined the benefits of renin-angiotensinaldosterone system inhibitors (RAASi) therapy uptitration in patients with HF and reduced ejection fraction. In fact, hyperkalemia often limits RAASi use, thereby negating or mitigating their clinical benefits. Finally, serum potassium levels in HF should be maintained within the range of 4.0–5.0 mmol/L, and although the correction of hyperkalemia does not appear to improve clinical outcomes per se, it may enable the optimal titration of RAASi, offering indirect clinical benefit. Keywords Potassium · Hyperkalemia · Hypokalemia · Heart failure · Morbidity · Mortality
Introduction Heart failure (HF) represents a global pandemic affecting up to 37.7 million people worldwide [1], with a prevalence of approximately 1–2% of the adult population in developed countries, rising to more than 10% among people older than 70 years of age [2–5]. Despite the significant advances in therapies and prevention, morbidity and mortality remain unacceptably high, imposing a significant High lights (1) Hypokalemia and low-normal potassium levels (serum potassium 5.0 mmol/L) appears to be a risk marker and not a risk factor for adverse clinical outcomes in HF. (3) The correction of hyperkalemia does not appear to improve clinical outcomes per se but may enable the optimal titration of RAASi, and thus offer indirect clinical benefit. (4) Serum potassium in HF should be maintained within the range of 4.0–5.0 mmol/L. * Panagiotis Korantzopoulos [email protected] 1
First Department of Cardiology, University of Ioannina Medical School, 45100 Ioannina, Greece
clinical and economic burden on the healthcare sector [6, 7]. Even more worrisome, the prevalence and the total cost of HF are expected to rise markedly in the coming years, with projections to 2030 estimating increases of 46% and 127%, respectively, as compared with 2012 [8]. Under these circumstances, elucidation of the HF pathophysiology and development of appropriate and cost-effective therapeutic strategies are imperative. HF has been recently categorized into three subtypes based on the measurement of the left ventricular ejection fraction (LVEF), i.e., HF wi
Data Loading...
