Skip to main content
SpringerLink
Log in

Hyperkalemia Risk and Treatment of Heart Failure

  • Chapter
  • First Online:
Managing the Kidney when the Heart is Failing

  • 728 Accesses

Abstract

The development of progressive renal dysfunction is indeed a frequent complication in heart failure (HF) and represents the consequence of the combined effects of progressive decay in cardiac output and renal perfusion pressure, in conjunction with excess renal vasoconstriction. In fact, factors predisposing the development of HF such as ageing, hypertension, and myocardial ischemia are also frequently accompanied by a diminished renal function. Frequently, the degree and impact of renal dysfunction and its impact on outcomes in patients with HF are often underdiagnosed and underestimated. This is especially relevant considering that a decreased renal function is associated with a significant increment in mortality in HF. Several evidences have demonstrated the efficacy of renin–angiotensin–aldosterone blockade as a relevant component of HF treatment. However, the benefits of HF therapy do not come without some risk, and hyperkalemia is a frequent finding, especially in presence of renal dysfunction. We will review the participation of the kidney in HF and the renal consequences of the treatment, with special emphasis on the risk of hyperkalemia and its management in daily clinical practice.

Originally published in Bakris, The Kidney in Heart Failure, ISBN: 978-1-4614-3693-5

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. US Department of Health and Human Services. Heart failure: evaluation and care of patients with left ventricular systolic dysfunction. Clinical Practice Guidelines no. 11, AHCPR publication no. 94-0612, June 1994.

    Google Scholar 

  2. Kannel WB, Ho K, Thom T. Changing epidemiological features of cardiac failure. Br Heart J. 1994;72 Suppl 2:S3–9.

    Article  PubMed  CAS  Google Scholar 

  3. Cohn JN. The management of chronic heart failure. N Engl J Med. 1996;335:490–8.

    Article  PubMed  CAS  Google Scholar 

  4. Sica DA, Hess M. Pharmacotherapy in congestive heart therapy: aldosterone receptor antagonism: interface with hyperkalemia in heart failure. Congest Heart Fail. 2004;10:259–64.

    Article  PubMed  CAS  Google Scholar 

  5. Lindeman RD, Tobin JD, Shock NW. Association between blood pressure and the rate of decline in renal function with age. Kidney Int. 1984;26:861–8.

    Article  PubMed  CAS  Google Scholar 

  6. Ruilope LM, Lahera V, Rodicio JL, Romero JC. Are renal hemodynamics a key factor in the development and maintenance of essential hypertension? Hypertension. 1994;23:3–9.

    Article  PubMed  CAS  Google Scholar 

  7. Eijkelkamp WB, de Graeff PA, van Veldhuisen DJ, et al. Prevention of Renal and Vascular End-Stage Disease (PREVEND) Study Group. Effect of first myocardial ischemic event on renal function. Am J Cardiol. 2007;100:7–12.

    Article  PubMed  Google Scholar 

  8. Muntner P, Coresh J, Powe NR, Klag MJ. The contribution of increased diabetes prevalence and improved myocardial infarction and stroke survival to the increase in treated end-stage renal disease. J Am Soc Nephrol. 2003;14:1568–77.

    Article  PubMed  Google Scholar 

  9. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137–47.

    PubMed  Google Scholar 

  10. Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J, for the ADHERE scientific advisory committee and investigators. High prevalence of renal dysfuncion and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Cardiac Fail. 2007;13:422–30.

    Google Scholar 

  11. Ljungman S, Kjekshus J, Swedberg K, for the Consensus Trial Group. Renal function in severe congestive heart failure during treatment with enalapril. Am J Cardiol. 1992;70:479–87.

    Google Scholar 

  12. Hillege HL, Girbes AR, de Kam PJ, et al. Renal function, neurohumoral activation and survival in patients with chronic heart failure. Circulation. 2000;102:203–10.

    Article  PubMed  CAS  Google Scholar 

  13. Shulman NB, Ford CE, Hall WD, et al. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. Hypertension. 1989;13(Suppl I):I80–93.

    Article  PubMed  CAS  Google Scholar 

  14. Ruilope LM, Campo C, Rodriguez-Artalejo F, Lahera V, Garcia-Robles R, Rodicio JL. Blood pressure and renal function: therapeutic implications. J Hypertens. 1996;14:1259–63.

    Article  PubMed  CAS  Google Scholar 

  15. Ruilope LM, Salvetti A, Jamerson K, et al. Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study. J Am Soc Nephrol. 2001;12:218–25.

    PubMed  CAS  Google Scholar 

  16. Culleton BF, Larson MG, Wilson PWF, Evans JC, Parfrey PS, Levy D. Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int. 1999;56:2214–9.

    Article  PubMed  CAS  Google Scholar 

  17. Ruilope LM, Barrios V, Volpe M. Renal implications of the renin-angiotensin-aldosterone system blockade in heart failure. J Hypertens. 2000;18:1545–51.

    Article  PubMed  CAS  Google Scholar 

  18. Anand IS, Bishu K, Rector TS, Ishani A, Kuskowski MA, Cohn JN. Proteinuria, chronic kidney disease and the effect of an angiotensin receptor blocker in addition to an angiotensin-converting enzyme inhibitor in patients with moderate to severe heart failure. Circulation. 2009;120:1577–84.

    Article  PubMed  CAS  Google Scholar 

  19. DeFronzo RA, Sherwin RS, Felig P, et al. Nonuremic diabetic hyperkalemia: possible role of insulin deficiency. Arch Intern Med. 1977;137:842–3.

    Article  PubMed  CAS  Google Scholar 

  20. Bratusch-Marrain PR, DeFronzo RA. Impairment of insulin-mediated glucose metabolism by hyperosmolarity in man. Diabetes. 1983;32:1028–34.

    Article  PubMed  CAS  Google Scholar 

  21. Rosa RM, Silva P, Young JB, et al. Adrenergic modulation of extrarenal potassium disposal. N Engl J Med. 1980;302:431–4.

    Article  PubMed  CAS  Google Scholar 

  22. Kurtzman NA, Gonzalez J, DeFronzo R, et al. A patient with hyperkalemia and metabolic acidosis. Am J Kidney Dis. 1990;15:333–56.

    PubMed  CAS  Google Scholar 

  23. Cody RJ, Ljungman S, Covit AB, et al. Regulation of glomerular filtration rate in chronic congestive heart failure patients. Kidney Int. 1988;34:361–7.

    Article  PubMed  CAS  Google Scholar 

  24. Obialo CI, Ofili EO, Mirza T. Hyperkalemia in congestive heart failure patients aged 63 to 85 years with subclinical renal disease. Am J Cardiol. 2002;90:663–5.

    Article  PubMed  CAS  Google Scholar 

  25. Lawson DH, O’Connor PC, Jick H. Drug attributed alterations in potassium handling in congestive cardiac failure. Eur J Clin Pharmacol. 1982;23:21–5.

    Article  PubMed  CAS  Google Scholar 

  26. Bakris GL, Siomos M, Richardson D, et al. ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. Kidney Int. 2000;58:2084–92.

    Article  PubMed  CAS  Google Scholar 

  27. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316:1429–35.

    Google Scholar 

  28. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.

    Google Scholar 

  29. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. 1992;327:685–91.

    Google Scholar 

  30. de Denus S, Tardif JC, White M, et al. Quantification of the risk and predictors of hyperkalemia in patients with left ventricular dysfunction: a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) trials. Am Heart J. 2006;152:705–12.

    Article  PubMed  Google Scholar 

  31. Dickstein K, Kjekshus J, for the OPTIMAAL Steering Committee of the OPTIMAAL Study Group. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: The OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan. Lancet. 2002;360:752–60.

    Google Scholar 

  32. Cohn JN, Tognoni G, for the Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med. 2001;345:1667–75.

    Google Scholar 

  33. Pfeffer MA, Sweberg K, Granger CB, et al. CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003;362:759–66.

    Google Scholar 

  34. McMurray JJ, Ostergren J, Swedberg K, et al. CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function treated with an ACE inhibitor: the CHARM-Added trial. Lancet. 2003;362:767–71.

    Google Scholar 

  35. Granger CB, McMurray JJ, Yusuf S, et al. CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function and intolerant to ACE inhibitors: the CHARM-Alternative trial. Lancet. 2003;362:772–6.

    Google Scholar 

  36. Yusuf S, Pfeffer MA, Swedberg K, et al. CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and preserved left ventricular systolic function: the CHARM-Preserved trial. Lancet. 2003;362:777–81.

    Google Scholar 

  37. Desai AS, Swedberg K, McMurray JJV, et al. Incidence and predictors of hyperkalemia in patients with heart failure. J Am Coll Cardiol. 2007;50:1959–66.

    Article  PubMed  CAS  Google Scholar 

  38. Cohen-Solal A, McMurray JJV, Swedberg K, et al. Benefits and safety of candesartan treatment in heart failure are independent of age: insights from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity programme. Eur Heart J. 2008;29:3022–8.

    Article  PubMed  CAS  Google Scholar 

  39. Dzau VJ, Sasamura H, Hein L. Heterogeneity of angiotensin synthetic pathways and receptor subtypes—physiological and pharmacological implications. J Hypertens. 1993;11:S13–8.

    CAS  Google Scholar 

  40. Konstam MA, Neaton JD, Dickstein K, et al., for the HEAAL Investigators. Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. Lancet. 2009;374:1840–8.

    Google Scholar 

  41. Phillips CO, Kashani A, Ko DK, Francis G, Krumholz HMK. Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction. Arch Intern Med. 2007;167:1930–6.

    Article  PubMed  CAS  Google Scholar 

  42. Pfeffer MA, McMurray JJ, Velazquez EJ, et al., for the Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both [published correction appears in N Engl J Med. 2004;350:203]. N Engl J Med. 2003;349:1893–1906.

    Google Scholar 

  43. Hunt SA, Abraham WT, Chin MH, et al. American College of Cardiology. American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005;112: e154–235.

    Google Scholar 

  44. Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern? Arch Intern Med. 2000;160:685–93.

    Article  PubMed  CAS  Google Scholar 

  45. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709–17.

    Article  PubMed  CAS  Google Scholar 

  46. Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004;351:543–51.

    Article  PubMed  CAS  Google Scholar 

  47. Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309–21. Erratum in: N Engl J. 2003;348:2271.

    Article  PubMed  CAS  Google Scholar 

  48. Staessen JA, Li Y, Richart T. Oral renin inhibitors. Lancet. 2006;368:1449–56.

    Article  PubMed  CAS  Google Scholar 

  49. Birkenhager WH, Staessen JA. Dual inhibition of the renin system by aliskiren and valsartan. Lancet. 2007;370:195–6.

    Article  PubMed  Google Scholar 

  50. Seed A, Gardner R, McMurray J, et al. Neurohumoral effects of the new orally active renin inhibitor, aliskiren, in chronic heart failure. Eur J Heart Fail. 2007;9:1120–7.

    Article  PubMed  CAS  Google Scholar 

  51. McMurray JJV, Pitt B, Latini R, et al., for the Aliskiren Observation of Heart Failure Treatment (ALOFT) Investigators. Circ Heart Fail. 2008;1:17–24.

    Google Scholar 

  52. Gehr TWB, Sica DA. Hyperkalemia in congestive heart failure. Congest Heart Fail. 2001;7:97–100.

    Article  PubMed  Google Scholar 

  53. Shah KB, Rao K, Sawyer R, Gottlieb SS. The adequacy of laboratory monitoring in patients treated with spironolactone for congestive heart failure. J Am Coll Cardiol. 2005;46:845–9.

    Article  PubMed  CAS  Google Scholar 

  54. Vanpee D, Swine CH. Elderly heart failure patients with drug-induced serious hyperkalemia. Aging. 2000;12:315–9.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology Department, Hypertension Unit, Hospital 12 de Octubre, Av. CĂłrdoba s/n, 28041, Madrid, Spain

    Julian Segura & Luis M. Ruilope

Authors
  1. Julian Segura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luis M. Ruilope
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis M. Ruilope .

Editor information

Editors and Affiliations

  1. ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC1027, Chicago, 60637, Illinois, USA

    George L. Bakris

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Segura, J., Ruilope, L.M. (2012). Hyperkalemia Risk and Treatment of Heart Failure. In: Bakris, G. (eds) Managing the Kidney when the Heart is Failing. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-3691-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-3691-1_3

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4614-3690-4

  • Online ISBN: 978-1-4614-3691-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation