Patients with hyperkalemia less likely to receive RAAS inhibitors, have worse HF outcomes
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Key takeaways:
- Fewer patients with hyperkalemia were prescribed renin-angiotensin-aldosterone system inhibitors for HF.
- Patients with hyperkalemia were more likely to experience hospitalization for worsening HF or CV death.
Chinese adults with HF and dyskalemia were less likely to receive renin-angiotensin-aldosterone system inhibitors than patients with normokalemia, and those with hyperkalemia were more likely to experience worsening HF or CV death.
Dyskalemia, either hypokalemia or hyperkalemia, is a common complication of HF due to the pathophysiologic changes underlying HF and HF medications used; dyskalemia also increases the risk for potentially fatal cardiac arrhythmias, Jingmin Zhou, MD, PhD, of Shanghai Institute of Cardiovascular Disease at Fudan University, China, and colleagues wrote in the study background.
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“Hyperkalemia may also dictate dose reduction or discontinuation of HF treatments, resulting in poor prognoses,” Zhou and colleagues wrote. “While current Chinese guidelines recommend renin-angiotensin-aldosterone system (RAAS) inhibitors to treat HF, RAAS treatment is reportedly underutilized in China. Among Western patients with HF, both hypokalemia and hyperkalemia are associated with increased mortality risk compared with normokalemia, showing a U‐shaped relationship. Patients with hyperkalemia are also more likely to discontinue RAAS treatment than others. To our knowledge, such data among Chinese patients with HF are lacking.”
In a secondary analysis, Zhou and colleagues analyzed data from 6,950 adults with HF hospitalized between January 2013 and June 2015 who had at least one baseline serum potassium measurement and 3 years of follow-up, using data from the China National Heart Failure Registry. The mean age of patients was 70 years; 59.3% were men, 67.9% had hypertension, 31.1% had type 2 diabetes and 11% had chronic kidney disease. Researchers compared use of RAAS inhibition at baseline and clinical outcomes during follow-up across patients with normokalemia (potassium > 3.5-5 mmol/L), hypokalemia (potassium 0-3.5 mmol/L) and hyperkalemia (potassium > 5 mmol/L). The primary endpoint was the proportion of patients in each potassium category who experienced a composite of rehospitalization for worsening HF or CV death during follow‐up.
The findings were published in Clinical Cardiology.
Within the cohort, 79.6% of patients had normokalemia, 16% had hypokalemia and 4.4% had hyperkalemia.
The use of ACE inhibitors or angiotensin receptor blockers (ARBs) differed across potassium groups (P = .0001) and was reported among 64.1%, 63.4%, and 54.5% of patients with hypokalemia, normokalemia and hyperkalemia, respectively.
Overall, 26.6% of patients with hypokalemia, 28.6% of patients with normokalemia and 36% of patients with hyperkalemia experienced rehospitalization for worsening HF or CV death (P = .0057 for between‐group comparison).
“While we did not assess the association between RAAS inhibitor use and clinical outcomes in this study, our data support real‐world Western studies where patients who discontinued RAAS inhibitors, or those on reduced doses due to hyperkalemia, exhibited increased incidence of major adverse cardiac events and mortality than those on maximum dose,” the researchers wrote.
The researchers noted that several variables, including patients’ diet, medications, potassium supplementation and the causes of hyperkalemia, were not available to adjust for confounding.
“Compared with the hypo‐ and normokalemia groups, a lower proportion of patients with hyperkalemia were prescribed ACE inhibitors or ARBs for the treatment of HF at baseline, but a higher proportion experienced rehospitalization for worsened HF, CV mortality, and all‐cause mortality after discharge regardless of HF type,” the researchers wrote. “The effective management of hyperkalemia in patients with HF should be evaluated for its potential to allow optimal use of RAAS inhibitor treatment and to improve clinical outcomes.”
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