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Hyperkalaemia in Cardiological Patients: New Solutions for an Old Problem

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Abstract

Hyperkalaemia is one of the most common electrolyte disorders in patients with cardiovascular disease (CVD). The true burden of hyperkalaemia in the real-world setting can be difficult to assess, but in population-based cohort studies up to 4 in 10 patients developed hyperkalaemia. In addition to drugs interfering with potassium metabolism and food intake, several conditions can cause or worsen hyperkalaemia, such as advanced age, diabetes, and chronic kidney disease. Mortality, cardiovascular morbidity, and hospitalisation are higher in patients with hyperkalaemia. Hyperkalaemia represents a major contraindication or a withholding cause for disease-modifying therapies like renin–angiotensin–aldosterone inhibitors (RAASi), mainly mineralocorticoid receptor antagonists. Hyperkalaemia can be also classified as acute and chronic, according to the onset. Acute hyperkalaemia is often a life-threatening emergency requiring immediate treatment to avoid lethal arrhythmias. Therapy goal is cell membrane stabilisation by calcium administration, cellular intake, shift of extracellular potassium to the intracellular space (insulin, beta-adrenergic agents, sodium bicarbonate), and increased elimination with diuretics or dialysis. Chronic hyperkalaemia was often managed with dietary counselling to prevent potassium-rich food intake and tapering of potassium-increasing drugs, mostly RAASi. Sodium polystyrene sulphonate, a potassium binder, was the only therapeutic option. Recently, new drugs such as patiromer and sodium zirconium cyclosilicate give new opportunities for the treatment of hyperkalaemia, as they proved to be safe, well tolerated, and effective. Aim of this review is to describe the burden of hyperkalaemia in cardiovascular patients, its direct and indirect effects, and the therapeutic options now available in the acute and chronic setting.

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Authors and Affiliations

  1. Chairperson Working Group On Cardiological Chronicity ANMCO, Cardiology Unit, P. Borsellino Hospital, ASP Trapani, M.D., Via F. Crispi 6, 91025, Marsala, Italy

    Maurizio Giuseppe Abrignani

  2. Chairperson Cardiorenal and Metabolic Working Group ANMCO; Medicine and Medicine Sub-Specialties Department, Cardio Renal Program, UOC Nephrology, Dialysis and Adult Renal Transplant Program, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy

    Edoardo Gronda

  3. Chairperson Working Group On Heart Failure ANMCO; Department, Cardiology-ICCU, Marche University Hospital, Ancona, Italy

    Marco Marini

  4. Cardiology Division, Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy

    Mauro Gori

  5. Cardiology Unit, Ospedali Riuniti, Foggia, Italy

    Massimo Iacoviello

  6. Division of Cardiac Rehabilitation, ICS Maugeri, IRCCS Gattico-Veruno, Piedmont, Italy

    Pier Luigi Temporelli

  7. Cardiology Unit, Ospedale Civile G. Mazzini, Teramo, Italy

    Manuela Benvenuto

  8. Cardiology Unit, ARNAS G. Brotzu, Cagliari, Italy

    Giulio Binaghi

  9. Cardiology Unit, AORN Sant’Anna E San Sebastiano, Campania University “L. Vanvitelli,” Napoli, Caserta, Italy

    Arturo Cesaro

  10. Cardiotoracovascular Department, ASST GOM Niguarda Cà Granda, “A. De Gasperis, Cardiology 4, Milan, Italy

    Alessandro Maloberti

  11. Cardiology-ICCU UOC, A.O. San Camillo Forlanini, Rome, Italy

    Maria Denitza Tinti & Domenico Gabrielli

  12. Cardiovascular Department, Post-Acute Patient Follow-Up UOSD, AORN, Sant’ Anna and San Sebastiano, Caserta, Italy

    Carmine Riccio

  13. Clinical and Rehabilitative Cardiology UOC, ASL Roma 1, P.O. San Filippo Neri, Rome, Italy

    Furio Colivicchi

  14. Cardiology UOC, Ospedale Miulli, Acquaviva Delle Fonti, Bari, Italy

    Massimo Grimaldi

  15. Heart Care Foundation, Florence, Italy

    Domenico Gabrielli

  16. Cardiotoracovascular Department “A. De Gasperis, ASST GOM Niguarda Cà Granda, ICCU, Cardiology 1 - Haemodynamics UOC, Milan, Italy

    Fabrizio Oliva

  17. ANMCO, Florence, Italy

    Fabrizio Oliva

Authors
  1. Maurizio Giuseppe Abrignani
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  2. Edoardo Gronda
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  3. Marco Marini
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  4. Mauro Gori
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  5. Massimo Iacoviello
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  6. Pier Luigi Temporelli
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  7. Manuela Benvenuto
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  8. Giulio Binaghi
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  9. Arturo Cesaro
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  10. Alessandro Maloberti
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  11. Maria Denitza Tinti
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  12. Carmine Riccio
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  13. Furio Colivicchi
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  14. Massimo Grimaldi
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  15. Domenico Gabrielli
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  16. Fabrizio Oliva
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Consortia

on behalf of the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Working Groups on Cardiological Chronicity, Cardiorenal, Metabolic, Heart Failure

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Maurizio Giuseppe Abrignani, Edoardo Gronda, and Marco Marini. The first draft of the manuscript was written by Mauro Gori, Massimo Iacoviello, Pier Luigi Temporelli, Manuela Benvenuto, Giulio Binaghi, Arturo Cesaro, Alessandro Maloberti, and Maria Denitza Tinti, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maurizio Giuseppe Abrignani.

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Abrignani, M.G., Gronda, E., Marini, M. et al. Hyperkalaemia in Cardiological Patients: New Solutions for an Old Problem. Cardiovasc Drugs Ther (2024). https://doi.org/10.1007/s10557-024-07551-7

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