Hyperkalemia as a limiting factor of neurohormonal blockade/modulation in everyday clinical practice

• Type: Article in National Scientific Journal
• Date: 2022

Authors

Vasconcelos, H (Author) Other; Cabral, J (Author) Other; Moreira, E (Author) FMUP; Campelo, M (Author) FMUP; Amorim, S (Author) FMUP; Moura, B (Author) FMUP; Sousa, A (Author) FMUP; Pinto, R (Author) Other; Maia Araujo, P (Author) FMUP; Dias, C (Author) Other; Silva Cardoso, J (Author) FMUP

Journal

Title: Revista Portuguesa de Cardiologia

ISSN: 0870-2551

Publisher: Sociedade Portuguesa De Cardiologia

Indexing

ISI Web of Knowledge - 0 Citations

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Other information

Authenticus ID: P-00W-G8N

DOI: 10.1016/j.repc.2021.04.007

Abstract (EN): Introduction and objectives: Neurohormonal blockade (NB)/modulation is the combination of two renin-angiotensin-aldosterone system inhibitors (RAASi) with a beta blocker. It is the core therapy for heart failure with reduced ejection fraction (HFrEF). While improving long term prognosis, it also induces hyperkalemia (serum K+ >5.0 mEq/L) due to RAASi effects. This may cause lethal arrhythmias and increase mortality in the short term. Thus, hyperkalemia frequently leads to withholding or reducing the intensity of neurohormonal blockade/modulation, which is associated with worsening long term prognosis. We assessed the relevance of hyperkalemia as a limiting factor of neurohormonal blockade/modulation in real life clinical conditions. Methods: We reviewed the medical records of HFrEF patients attending a HF clinic at a tertiary Portuguese hospital during 2018 (n=240). The number of patients not tolerating maximal neurohormonal blockade/modulation due to hyperkalemia was determined. The incidence and characteristics of hyperkalemia episodes were also assessed. Results: Only six patients (3%) achieved maximal doses of neurohormonal blockade/modulation. Hyperkalemia was the limiting factor in 48 (20%) patients. A total of 185 hyperkalemia episodes occurred in 100 (42%) patients. Forty-five (24%) episodes were moderate or severe (serum K+ >5.5 mEq/L). In these HFrEF patients, the co-existence of hypertension, diabetes or renal failure was associated with the occurrence of hyperkalemia. Conclusions: In daily clinical practice, hyperkalemia is frequent and limits neurohormonal blockade/modulation by leading to the withholding or reducing of the intensity of RAAS inhibition. Considering the negative prognostic impact associated with sub-optimal neurohormonal blockade/modulation, addressing hyperkalemia is an important issue when treating HFrEF patients. (C) 2022 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7