Hyperkalemia in Heart Failure.
Disorders of potassium homeostasis can potentiate the already elevated risk of arrhythmia in heart failure. Heart failure patients have a high prevalence of chronic kidney disease, which further heightens the risk of hyperkalemia, especially when renin-angiotensin-aldosterone system inhibitors are used. Acute treatment for hyperkalemia may not be tolerated in the long term. Recent data for patiromer and sodium zirconium cyclosilicate, used to treat and prevent high serum potassium levels on a more chronic basis, have sparked interest in the treatment of hyperkalemia, as well as the potential use of renin-angiotensin-aldosterone system inhibitors in patients who were previously unable to take these drugs or tolerated only low doses. This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally treat heart failure.
Cardiology Division, Stony Brook University, Stony Brook, New York.
Chaudhry M S
CM
Sarwar
Cardiology Division, Stony Brook University, Stony Brook, New York.
Lampros
L
Papadimitriou
Cardiology Division, University of Michigan, Ann Arbor, Michigan.
Bertram
B
Pitt
Cardiology Division, Albert Einstein College of Medicine; Bronx, New York.
Ileana
I
Piña
INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, and the Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France.
Faiez
F
Zannad
Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center, Göttingen, Germany.
Stefan D
SD
Anker
Center for Cardiovascular Drug Development and Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Mihai
M
Gheorghiade
Cardiology Division, Stony Brook University, Stony Brook, New York. Electronic address: javed.butler@stonybrookmedicine.edu.
Javed
J
Butler
D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D006947:Hyperkalemia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007674:Kidney Diseases / Q000150:complications; D011108:Polymers / Q000627:therapeutic use; D017640:Silicates / Q000627:therapeutic use
D011108:Polymers; D017640:Silicates; C568789:patiromer; C000597310:sodium zirconium cyclosilicate
angiotensin-converting enzyme inhibitors; angiotensin-receptor blockers; chronic kidney disease; mineralocorticoid receptor antagonist; patiromer; sodium zirconium cyclosilicate