Potassium Disturbances Common in Patients Hospitalized With Heart Failure

By Reuters Staff

October 23, 2019

NEW YORK (Reuters Health) - Inpatient therapy for heart failure may induce iatrogenic hypokalemia or hyperkalemia, which in themselves appear not to be harmful - but related changes in medication might be, according to an international group of researchers.

Intensification of diuretic therapy may cause hypokalemia. whereas initiation or dose adjustments of therapies such as RAAS inhibitors may cause hyperkalemia, Dr. Peter van der Meer of University Medical Center Groningen, in the Netherlands, and colleagues note in JACC: Heart Failure, online October 9.

The researchers studied data on close to 1,600 hospitalized heart-failure patients taking part in a clinical trial. Daily measurements of serum potassium were made from baseline until discharge or day 7 of hospitalization. All subjects had measurements covering at least five days of this hospital admission.

Overall serum potassium concentrations increased significantly, from 4.3 mEq/L at baseline to 4.5 mEq/L at discharge or day 7. Incident hypokalemia was seen in 17% and incident hyperkalemia in 35% of patients.

Thirty-four patients (2%) had episodes of both hypo- and hyperkalemia.

After adjusting for confounders, patients who developed incident hyperkalemia were found more often to be on mineralocorticoid antagonists (MRAs) prior to hospitalization and to have their dose decreased or discontinued during hospitalization.

Overall, 17% patients died within 180 days and 27% experienced the composite secondary outcome of rehospitalization for cardiovascular or renal causes or all-cause mortality through 60 days.

No association was seen between incident hypo- or hyperkalemia and either the primary or the composite outcome. However, say the researchers, the number of days a patient suffered from hyperkalemia was associated with significantly increased 180-day mortality, even after adjustment (hazard ratio, 1.14).

Regardless of incident hyperkalemia, down-titration of MRAs during hospitalization was independently associated with 180-day mortality (HR, 1.73).

Those who were discharged on the same or an increased dose of MRAs had a reduced 180-day mortality (HR, 0.52). This was also the case in patients receiving ACE inhibitors or ARBs (HR, 0.47).

"Survival analyses," the researchers conclude, "indicate that patients still benefit from constant doses or up-titration of (these agents) despite incident hyperkalemia in a clinical setting."

Dr. van der Meer did not respond to requests for comments.

SOURCE: https://bit.ly/2Bx8msd

JACC Heart Fail 2019.


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