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

Autores da FMUP

• Emilia Da Conceição Torres Dias Moreira

  Autor

• Manuel Belchior Campelo

  Autor

• Sandra Maria Resende Amorim

  Autor

• Brenda Eugénia Carvalho De Moura Cardoso

  Autor

• Alexandra Isabel Coelho De Sousa

  Autor

• Roberto Rodrigues Pinto

  Autor

• José Carlos De Magalhães Silva Cardoso

  Autor

Participantes de fora da FMUP

• Vasconcelos, H
• Cabral, J
• Maia-Araújo, P
• Dias, C

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina

• Recursos Comuns

  

  Investigador

  Guilhermina Maria Da Silva Rêgo

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

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.

Keywords

• Hyperkalemia; Heart failure; Therapy; Neurohormonal blockade; Neurohormonal modulation; RAAS inhibition