Current Heart Failure Reports

, Volume 15, Issue 6, pp 390–397 | Cite as

Hyperkalaemia in Heart Failure—Pathophysiology, Implications and Therapeutic Perspectives

  • Redi LlubaniEmail author
  • Davor Vukadinović
  • Christian Werner
  • Nikolaus Marx
  • Stephen Zewinger
  • Michael Böhm
Comorbidities of Heart Failure (C Angermann, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Comorbidities of Heart Failure


Purpose of Review

Hyperkalaemia is a frequent and sometimes life-threatening condition that may be associated with arrhythmia and cardiac dysfunction. Evaluating the prevalence of hyperkalaemia in patients with heart failure (HF) and potential treatments of this condition is essential for patients using renin–angiotensin–aldosterone system inhibitors or angiotensin receptor–neprilysin inhibitor and mineralocorticoid receptor antagonists, which represent the cornerstone and highly proven life-saving therapy.

Recent Findings

Novel findings from the past few years include data regarding the epidemiology, pathomechanisms, implications and novel therapeutic approaches to counteract hyperkalaemia in patients with HF. Whilst older potassium-binding agents are associated with serious adverse events, novel potassium-binding drugs are effective in lowering potassium levels and are generally well tolerated.


Hyperkalaemia represents both a direct risk of cardiovascular complication and an indirect biomarker of the severity of the underlying disease such as neurohormonal activation and renal dysfunction. Novel potassium-binding drugs such as patiromer and sodium zirconium cyclosilicate may help to optimize therapy in HF and achieve guideline-recommended doses.


Hyperkalaemia Cardiovascular mortality Heart failure Sacubitril/valsartan Renin–angiotensin–aldosterone system ZS-9 Patiromer 


Funding Information

This work was supported by the German Research Foundation (DFG) SBF TRR219 projects C09, M02, M03, M05, M06 and S01.

Compliance with Ethical Standards

Conflict of Interest

Redi Llubani, Davor Vukadinović, Christian Werner, Nikolaus Marx and Stephen Zewinger declare no conflicts of interest.

Michael Böhm reports personal fees from Amgen, personal fees from Bayer, personal fees from Servier, personal fees from Medtronic, personal fees from Boehringer Ingelheim, personal fees from Vifor and personal fees from Bristol Myers Squibb, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Redi Llubani
    • 1
    Email author
  • Davor Vukadinović
    • 1
  • Christian Werner
    • 1
  • Nikolaus Marx
    • 2
  • Stephen Zewinger
    • 3
  • Michael Böhm
    • 1
  1. 1.Department for Internal Medicine III, Cardiology, Angiology and Intensive Care MedicineSaarland University Medical CenterHomburgGermany
  2. 2.Department of Internal Medicine IRWTH Aachen UniversityAachenGermany
  3. 3.Department for Internal Medicine IV, NephrologySaarland University Medical CenterHomburgGermany

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