Management of RAASi-associated hyperkalemia in patients with cardiovascular disease

• Type: Article in International Scientific Journal
• Date: 2021

Authors

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

Journal

Title: Heart Failure Reviews

Vol. 26

Pages: 891-896

ISSN: 1382-4147

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 19 Citations

Other information

Authenticus ID: 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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 6