Why are patients with cardiovascular issues at higher risk of developing hyperkalemia (high serum potassium level)?

Updated: Apr 09, 2020
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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As cardiovascular therapy has evolved, the growing population of patients with chronic heart failure also has come to constitute a high-risk group. The factors promoting the development of hyperkalemia in these patients include underlying renal insufficiency due to poor cardiac output and reduced renal blood flow, as well as the high prevalence of diabetes mellitus in patients with heart failure and the growing use of ACE inhibitors, ARBs, aldosterone inhibitors (eg, spironolactone), and direct renin inhibitors (eg, aliskiren), alone and in combination. [20, 21, 49, 50, 51]

Initial studies examining the risk of hyperkalemia in patients with heart failure who were treated with aldosterone inhibitors revealed only a minor increase in hyperkalemia. However, later studies showed that as the treatment became more widespread, morbidity and mortality from hyperkalemia increased. [52]

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