Management of RAASi-associated hyperkalemia in patients with cardiovascular disease

• Tipo: Artigo em Revista Científica Internacional
• Data: 2021

Autores

Silva Cardoso, J (Autor) FMUP; Brito, D (Autor) Outra; João Frazão (Autor) FMUP; Ferreira, A (Autor) Outra; Bettencourt, P (Autor) Outra; Branco, P (Autor) Outra; Fonseca, C (Autor) Outra

Revista

Título: Heart Failure Reviews

Vol. 26

Páginas: 891-896

ISSN: 1382-4147

Editora: Springer Nature

Indexação

ISI Web of Knowledge - 0 Citações

Scopus - 19 Citações

Outras Informações

ID Authenticus: P-00T-HMM

DOI: 10.1007/s10741-020-10069-3

Abstract (EN): Renin-angiotensin-aldosterone system inhibitors (RAASi) reduce morbidity and mortality in heart failure (HF) with reduced ejection fraction in a dose-dependent manner. They also have a positive impact in other cardiovascular diseases (CVDs). However, RAASi may induce hyperkalemia, a potentially life-threatening disorder. This risk is further increased in those with concomitant chronic kidney disease, diabetes mellitus, and/or in patients with hypertension. Current treatment guidelines recommend maximal RAASi dosing to improve clinical outcomes; however, this is often limited by the development of hyperkalemia. When this occurs, current guidelines recommend RAASi down-titration/interruption, which, while improving short-term prognosis, is associated with a negative long-term prognostic impact. At present, the European Society of Cardiology suggests the consideration of novel potassium binders (patiromer and sodium zirconium cyclosilicate) for the management of RAASi-associated hyperkalemia. Both drugs can reduce serum potassium levels and prevent recurrent hyperkalemia. Additionally, patiromer showed enabling of RAASi optimization in high-risk patients. Nevertheless, precise recommendations on the use of these drugs are lacking. Building upon current HF guideline recommendations, a multidisciplinary expert panel convened to design an algorithm providing practical guidance on the use of novel potassium binders/patiromer in patients with HF and/or other CVD. As a result of that effort, we present an evidence-based treatment algorithm for the management of hyperkalemia with novel potassium binders/patiromer in patients with HF and/or other CVD receiving RAASi, including the necessary monitoring to avoid induction of hypokalemia. This algorithm aims to maintain or up-titrate RAASi to optimized doses, while maintaining normokalemia, improved clinical outcomes, and long-term prognosis.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 6