Portal de investigação
Hyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review
Data de publicação:
Autores da FMUP
Participantes de fora da FMUP
- Fonseca, C
- Brito, D
- Branco, P
- Silva Cardoso, J.
- Bettencourt, P
Unidades de investigação
Abstract
Introduction and Objectives: Renin-angiotensin-aldosterone system inhibitors (RAASi) are the cornerstone of treatment of heart failure with reduced ejection fraction (HFrEF). RAASi optimization in real-life care is challenged by hyperkalemia, a potentially fatal adverse event, which can necessitate downtitration or discontinuation of RAASi and negatively impact survival in HFrEF. The literature on this problem is sparse. We performed a systematic review of studies on HFrEF to investigate the prevalence, incidence, and risk factors of hyperkalemia, RAASi prescription rates, frequency of RAASi downtitration or discontinuation due to hyperkalemia, and the potential negative effect of the latter on prognosis. Methods: We conducted a MEDLINE (PubMed) search including observational and interventional studies published between January 1987 and May 2018. Results: A total of 30 observational and 18 interventional studies were included in the review. The incidence of hyperkatemia reported was between 0% and 63% in observational studies and was between 0% and 30% in clinical trials. Risk factors for hyperkalemia included RAASi prescription, older age, diabetes, and chronic kidney disease. In real-life studies, RAASi were downtitrated or discontinued in 3-22% of HFrEF patients; hyperkatemia was the reported cause in 5% of cases. No reports were found on the impact on prognosis of RAASi downtitration or discontinuation due to hyperkatemia. Conclusions: Hyperkatemia and RAASi downtitration or discontinuation are frequent, particularly in real-life HFrEF studies. Further research is needed to clarify the role of RAASi downtitration or discontinuation due to hyperkatemia and to assess its tong-term prognostic impact in HFrEF patients. (C) 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U.
Dados da publicação
- ISSN/ISSNe:
- 0870-2551, 2174-2030
- Tipo:
- Review
- Páginas:
- 517-541
- Link para outro recurso:
- www.scopus.com
Revista Portuguesa de Cardiologia Sociedade Portuguesa De Cardiologia
Citações Recebidas na Web of Science: 5
Citações Recebidas na Scopus: 9
Documentos
- Não há documentos
Filiações
Keywords
- Clinical decision-making; Clinical outcomes.; Drug therapy; Heart failure; Hyperkalemia; Renin-anigotensin aldosterone system inhibitors
Financiamento
Proyectos asociados
Kidney-induced osteoporosis: a new entity with a novel therapeutic approach.
Investigador Principal: João Miguel Machado Dória Frazão
Estudo Clínico Académico . 2020
Citar a publicação
Fonseca C,Brito D,Branco P,Frazao JM,Silva J,Bettencourt P. Hyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review. Rev Port Cardiol. 2020. 39(9):p. 517-541. IF:1,374. (4).
