Hyperkalemia in heart failure. New treatments on the horizon
Dékány Miklós, Vágány Dénes, Szabó Márta, Nyolczas Noémi, Kiss Róbert Gábor
MH EK, Kardiológiai Osztály, Budapest
In the pharmacological treatment of heart failure with reduced ejection fraction (HFrEF) extraordinary success was achieved in the last 30 years. With the optimal use of neurohormonal antagonists significant decrease in morbidity and mortality was reached. With the use of the optimal medical treatment, a decrease can be measured not only in the mortality caused by progressive heart failure, but also in the risk of the sudden cardiac death.
New studies show a substantial progress in the use of these medications, but they also indicate that these drugs are being used in lower doses compared to the guideline recommendations, so the rate of favourable effects of the treatment is questionable.
One among the multiple factors that may attribute to lower therapeutic doses is hyperkalemia during the use of renin-angiotensin-aldosterone system inhibitors (RAASi). It is particularly common in patients with renal failure, diabetes mellitus, in conditions which further necessitate the need of the effective neurohormonal antagonist treatment. The high serum potassium level further increases the risk of the malignant heart rhythm disturbances and sudden cardiac death, which is otherwise high in the HFrEF.
Until now there was no treatment to keep the potassium level in the normal range without serious side effects next to the optimal use of RAASi.
This review will discuss the epidemiology of hyperkalemia, its effect on the outcome of heart failure, and on the RAASi use. The opportunities of the prevention and the new possibilities of the long standing treatment of hyperkalemia will also be discussed.